- Cognizant (Honolulu, HI)
- ** Claims Quality Review ** ( remote ) This is a remote position open to any qualified applicant that lives in the United States. **Summary:** Our ... quality standards, processes and procedures and policies + Ensures the claims processing reps adhere to predetermined quality assurance standards and the… more
- Cognizant (Honolulu, HI)
- …and coverage guidelines and regulations + Experience in the analysis and processing of claims , utilization review / quality assurance procedures + Must be able ... to transform a variety of business operations. We are seeking **Fully Remote US Based** Claims Processors to join our growing team. The **Medical** ** Claims … more
- Otsuka America Pharmaceutical Inc. (Honolulu, HI)
- …Summary** We are seeking an experienced and dynamic Executive Director of R&D Global Quality to join our team. This pivotal role will be responsible for leading a ... global team focused on R&D Quality . This global role includes direct reports in the...be reported periodically to Senior Management through the Management Review process to ensure alignment with Company policy and… more
- Sedgwick (Honolulu, HI)
- …+ Compiles reviews and analyzes management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, ... Financial Services & Insurance Team Leader - Liability | Remote **PRIMARY PURPOSE** : To supervise the operation of...authority of the individual examiner. + Monitors third party claims ; maintains periodical review of litigated … more
- CBRE (Honolulu, HI)
- Property Management Manager ( Remote ) Job ID 241052 Posted 06-Oct-2025 Service line GWS Segment Role type Full-time Areas of Interest Property Management Location(s) ... Remote - US - Remote - US...Vendor Management: Source, vet, and handle service providers, ensuring quality and cost-effectiveness. + Documentation: Maintain detailed records of… more
- Bowman (Honolulu, HI)
- …reviewed by more senior staff to ensure application of sound techniques and principles. Review work produced by junior staff for quality assurance. **At the ... of values, various exhibits, partial and final liens. + Review , process, obtain approvals, code and accrue for subconsultant...that may arise as it relates to disputes, or claims + Act as liaison between operations and many… more
- Cardinal Health (Honolulu, HI)
- **_Hybrid or Remote Position Hours_** Monday - Friday, 8:00am - 4:30pm EST (or based on business need) **_What Contract and Billing contributes to Cardinal Health_** ... things done. **The Accounts Receivable Specialist is responsible for processing insurance claims and billing. They will work within the scope of responsibilities as… more
- Humana (Honolulu, HI)
- …you Come In Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in ... payments in our payer systems, and by ensuring correct claims payment and appropriate diagnosis related group (DRG) assignments....**Use your skills to make an impact** **WORK STYLE:** Remote /work at home. While this is a remote… more
- Otsuka America Pharmaceutical Inc. (Honolulu, HI)
- …based in Princeton, New Jersey. Otsuka maintains a hybrid work policy and remote options will be considered for US candidates. **Key Responsibilities:** + Streamline ... and refine GVE processes to ensure quality , compliance, and timely delivery of value evidence studies....and success of projects for the GVE department. Regularly review these metrics to identify areas for improvement. +… more
- Ford Motor Company (Honolulu, HI)
- …for the balance of the book . Proactively monitor key underwriting and claims metrics to identity emerging risks and opportunities . Collaborate with underwriting ... Develop effective processes, policies, procedures, and controls to ensure effective and quality underwriting . Increase the use of underwriting automation with the… more
- CenterWell (Honolulu, HI)
- …3 manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if an a grievance, appeal or ... 3 assists members, via phone or face to face, further/support quality related goals. Investigates and resolves member and practitioner issues. Decisions… more
- Datavant (Honolulu, HI)
- …realize our bold vision for healthcare. **Position Highlights** : + Full-time, remote Opportunity: Monday - Friday 9:30am-6pm + Call center environment; Heavy phones ... of information related telephone calls and inquiries accurately and timely. + Review , research, resolve and respond to inquiries that are received via telephone,… more
- Humana (Honolulu, HI)
- …first** The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex ... this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review of all… more
- Humana (Honolulu, HI)
- …with other Market CIOs: + Maintains end-to-end accountability for the ongoing quality control, development, and delivery of IT products and services for their ... initiatives. + Supports Medicaid IT leadership in preparing readiness review materials. + Acts as a point of delivery...+ Works closely with implementation teams to promote responsible, high- quality testing practices. + Guides the testing team in… more
- Humana (Honolulu, HI)
- …first** The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Begins to influence department's… more
- Humana (Honolulu, HI)
- …The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The Corporate Medical Director works on problems of ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana at Administrative… more
- Humana (Honolulu, HI)
- …health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical Director ... protect member PHI / HIPAA information This is a remote position. **Scheduled weekly hours** **:** 32 hours: four...need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families,… more
- Humana (Honolulu, HI)
- …Disability) coverages for all case sizes, using experience and manual rates. Independent review of client and competitor information, as well as ability to problem ... + Experience analyzing a wide variety of health or claims related data + Industry Related course work is...with Reinsurers. **Additional Information** Travel: While this is a remote position, occasional travel to Humana's offices for training… more
- Sumitomo Pharma (Honolulu, HI)
- …expert on all regulatory matters with key external stakeholders, internal steering/ review committees, business partners, and government entities on a global basis ... contact for internal communication + Ensure that development of launch materials/new claims with Marketing, Medical and Legal are guided by applicable regulatory… more