- Lincoln Financial (Honolulu, HI)
- …**Requisition #:** 74647 **The Role at a Glance** We are excited to bring on a Claims Customer Care Associate to join our claimant excellence team supporting ... coaching and development to perform in this fast-paced environment. As a Claims Customer Care Associate , you will be responsible for answering claimants… more
- Humana (Honolulu, HI)
- …and judgement to make determinations whether requested services, requested level of care , and/or requested site of service should be authorized. All work occurs ... of decisions to internal associates, and possible participation in care management. May occasionally participate in discussions with external physicians… more
- Evolent (Honolulu, HI)
- …a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to ... a mission with a company behind it. **What You'll Be Doing:** ** Associate Director, Performance Analytics - Oncology & Member Product Focus** **Overview:** Evolent… more
- Evolent (Honolulu, HI)
- …people with most complex and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented health care ... system and ensure people get the same level of care and compassion we would want for our loved...our specialty programs and administrative platform. Role Overview The Associate Director role on Client Analytics will support both… more
- Travelers Insurance Company (Honolulu, HI)
- **Who Are We?** Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our ... Claim Counsel team conducts thorough investigation, analysis, evaluation, and disposition of claims and claim litigation to achieve superior customer service and to… more
- Walgreens (Honolulu, HI)
- …pharmacist, including those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient ... Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages… more
- Walmart (Honolulu, HI)
- …Floor in accordance with Company policies and procedures by properly handling claims and returns, zoning the area, arranging and organizing merchandise, and ... digital tools to drive sales, improve the shopping experience, and elevate associate engagement; utilizing hand held technology to make immediate business decisions… more
- Walmart (Honolulu, HI)
- …thinking You will make an impact by: * Ensuring high-quality products are taken care of and available for our members * Ensuring shelves are clean, maintaining ... accordance with Company policies and procedures by properly handling claims and returns; zoning the area; receiving and stocking...Paid time off benefits include PTO, parental leave, family care leave, bereavement, jury duty, and voting. You will… more
- Humana (Honolulu, HI)
- …community and help us put health first** Design and maintain Medicaid claims analytics dataset using Databricks. Conduct in-depth analysis of healthcare claims ... Identify cost drivers, utilization patterns, and anomalies in Medicaid medical claims data. Maintain dashboards to communicate key trends to stakeholders. The… more
- Humana (Honolulu, HI)
- …looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and ... provider contract payments in our payer systems, and by ensuring correct claims payment and appropriate diagnosis related group (DRG) assignments. Analyzes, enters… more
- Queen's Health System (Honolulu, HI)
- …* Monitors work assignments to ensure accurate and timely billing of patient accounts, claims submissions and follow up on denied claims in accordance with ... AND LICENSURE: * High School diploma or equivalent education. * Associate 's or Bachelor's degree in business, finance, accounting, healthcare or related… more
- Humana (Honolulu, HI)
- …achieving operational and compliance key performance indicators. In addition, the associate will participate in cross functional teams and support analyzing business ... an impact** **Required Qualifications** + Minimum 1 year of experience in medical claims payment and processing + Minimum 1 year of experience analyzing and… more
- CenterWell (Honolulu, HI)
- …of the Pharmacy Analytics division, with responsibilities that include working with pharmacy claims data. The team to which this position reports is dedicated to ... PowerBI + Experience in Databricks is preferred + Experience in analyzing pharmacy claims data Travel: While this is a remote position, occasional travel to Humana's… more
- Humana (Honolulu, HI)
- …have expertise in conducting retrospective observational studies using administrative claims data using a collaborative approach across multiple stakeholders. Humana ... + An understanding of research methodology and the managed care arena, and how it applies to health outcomes...with cloud base analytics platforms + Experience with clinical, claims , pharmacy or other healthcare data. + Strategic thinking… more
- Highmark Health (Honolulu, HI)
- …+ High school diploma or GED + Experience in pharmacy prescription claims processing/submission/payment. **Preferred** + Associate degree + Pharmacy technician ... medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior… more
- Humana (Honolulu, HI)
- …health first** **Requires a strong foundation in COBOL mainframe development ** The Claims Adjudication System (CAS) team at Humana is essential in delivering core ... services through effective claims processing and management solutions. This position involves coding software applications based on business requirements and… more
- UMB Bank (Honolulu, HI)
- …insurance coverage through Bank's blanket program or external policy, facilitate insurance claims , taxation matters and payment, and that assets are reviewed in ... other insurance coverage; health savings, flexible spending, and dependent care accounts; adoption assistance; an employee assistance program; fitness reimbursement;… 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 ... and judgement to make determinations whether requested services, requested level of care , and/or requested site of service should be authorized. All work occurs… more
- Hawaii Pacific Health (Honolulu, HI)
- …(CPT) and International Classification of Diseases (ICD) codes. **Preferred Qualifications:** Associate 's degree in Business or Health Care Administration. ... Hawai'i Pacific Health is a not-for-profit health care network with over 70 locations statewide including...the accurate and timely preparation and submission of physician claims ; follow-up on accounts receivable; making necessary corrections to… more
- Hawaii Pacific Health (Honolulu, HI)
- Hawai'i Pacific Health is a not-for-profit health care network with over 70 locations statewide including medical centers, clinics, physicians and other caregivers ... serving Hawai'i and the Pacific Region with high quality, compassionate care . Its four medical centers - Kapi'olani, Pali Momi, Straub and Wilcox - specialize in… more