- HomeSafe Alliance (Honolulu, HI)
- …Raising awareness of any settlement practices, trends, or areas of concern to the Director of Claims . Responds to internal and external customer disputes and ... as needed to ensure prompt recovery of claim expenses. + Work with the Director of Claims and Claims Managers to ensure any concerns or issues are addressed.… more
- Humana (Honolulu, HI)
- …The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex ... requires an in-depth evaluation of variable factors. **Job Profile** The Medical Director actively uses their medical background, experience, and judgement to make… more
- Humana (Honolulu, HI)
- …a part of our caring community and help us put health first** The Medical Director 's primary responsibility is the review of medical authorizations or claims to ... the medical necessity of a given service or level of care. The Medical Director 's work assignments involve moderately complex to complex issues where the analysis of… more
- Humana (Honolulu, HI)
- …Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The Corporate Medical Director works on problems ... and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of… more
- Amentum (Honolulu, HI)
- The **Senior Director of Contracts** will report to the Vice President of Contracts and lead the Contracts team supporting the Critical Missions operating group at ... Amentum. The Senior Director will provide strategic direction and functional expertise to...prepare and effectively resolve Requests for Equitable Adjustment (REAs), Claims and other complex matters. + Excellent interpersonal, communications… more
- Spanish Peaks Mountain Club (Maui County, HI)
- …be considered. Please Click Here (https://www.myworkday.com/montage/d/task/1422$1471.htmld) to apply internally. Director of Security SUMMARY The Director of ... Experience in managing of Work Comp and General Liability claims + Security Guard Card certified + Advanced computer...camera systems and radios. The pay scale* for the Director of Security is $82,000.00 to $103,000.00. *The pay… more
- Magellan Health Services (Honolulu, HI)
- …Management Centers (CMC) and Shared Services, assurance of accuracy of claims payment and administrative policies, rate maximization through ongoing benefit analysis ... or appropriately escalates customer service issues in conjunction with operations ( claims , service, systems). + Prepares and presents Joint Operating Committee (JOC)… more
- Humana (Honolulu, HI)
- …of our caring community and help us put health first** The Associate Director , Value-Based Solutions will be responsible for leading the operational performance of ... Horizon's specialty value-based payment (VBP) model portfolio. The Associate Director will oversee a team of direct reports to...in Medicaid and Medicare managed care + Expertise performing claims data analysis to inform VBP model design +… more
- Highmark Health (Honolulu, HI)
- …a customer's financial experience - member and patient billing, benefits and claims , cost transparency, and health & spending accounts. Accountable for leading a ... team of product managers and product analysts focused on research & insights, problem/opportunity management, product strategy, roadmap management, and value case development. Partners across the Living Health organization and the Enterprise to engage key… more
- Marriott (Lahaina, HI)
- …* Works with the unemployment services provider to respond to unemployment claims ; reviews provider reports for accuracy and corrects errors. * Prepares, audits ... are referred to the Department Manager for resolution or escalated to the Director of Human Resources/Multi-Property Director of Human Resources. * Partners with… more
- Veterans Benefits Administration (Honolulu, HI)
- …direct counseling service (through in-person, Tele-counseling, and telephone contacts) and claims adjudication for benefits under the VA's VR&E Programs. VR&E is ... which can typically cost many thousands of dollars. Provides the Regional Office Director 's full-time assistant, the Assistant Director , who is authorized, a… more
- Marriott Vacations Worldwide (Lahaina, HI)
- …efficiently and creating a positive work culture among staff members. Supports Director of Operations in ensuring Hotel Operations meet the brand's standards, ... WORK ACTIVITIES** **Managing Security/Loss Prevention Operations** + Assists the Director of Engineering in administering fire prevention programs and emergency… more
- Hawaii Pacific Health (Honolulu, HI)
- …the managed care services department including referral management, patient steerage, and claims auditing. Under the general direction of the Department Director ... or designee, develops and applies methods to provide analytics and reporting services to support population health management, quality and cost initiatives for all Hawai'i Pacific Health hospitals, clinics and other entities including Hawai'i Health Partners.… more
- Marriott Vacations Worldwide (Honolulu, HI)
- …WORK ACTIVITIES** **Managing Security/Loss Prevention Operations** + Assists the Director of Engineering in administering fire prevention programs and emergency ... + Manages first aid program for owners/guests and associates. + Manages the claims process and protects company assets by closely monitoring the General Liability… more
- Highmark Health (Honolulu, HI)
- …ensure they utilize various means of automated communication, as well as, claims and electronic data interchange and electronic funds transfer. Collaborate with ... claim/member issues or provider file/record/directory discrepancies. Consult with dental director /dental advisers regarding clinical-related questions and policies, as well… more
- Cayuse Holdings (Honolulu, HI)
- …and contractual agreements. Manage audit processes and documentation to support financial claims and billing. + Stakeholder Engagement: Act as a key liaison between ... Proficiency in financial modeling, analysis, and reporting. **Reports to:** Director of Operations **Working Conditions** + Professional remote/hybrid office… more