Medical Claims Review Manager jobs in Honolulu, HI

Medical Claims Review Manager oversees the performance, productivity, and quality of the medical claims review staff. Responsible for hiring, training, and firing medical claims review staff. Being a Medical Claims Review Manager evaluates medical claims review processes and recommends process improvements. Serves as a technical resource for all medical review workers. Additionally, Medical Claims Review Manager typically requires an RN or BSN. Requires a bachelor's degree. Typically reports to a head of a unit/department. The Medical Claims Review Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Medical Claims Review Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)

H
Manager, Internal Ops Liaison, Claims
  • Hawaii Medical Service Association
  • Honolulu, HI FULL_TIME
  • Job Summary

    **Hybrid Work Environment - Must reside on Oahu **

    Pay Range: $73,154 - $121,252, position is eligible for an incentive bonus

    Note: Individuals typically begin between the minimum to middle of the pay range

    The Manager, Internal Ops Liaison, Claims is responsible for providing leadership direction and oversight of the daily claim operations. This results-oriented manager will be accountable for all facets of strategic initiatives, including implementation of policies, performance guarantees and programs in support of timely and accurate claims processing. Additionally, this Manager will represent Claims Operations in critical and/or complex inter departmental strategic goals and initiatives that directly impact operations.


    Exempt or Non-Exempt

    Exempt

    Minimum Qualifications

    • Bachelor's degree and five years of related work experience; or equivalent combination of education and work experience.
    • Three years of supervisory or management experience.
    • Deep understanding of claims processing procedures and documentation of controls.
    • Excellent verbal and written communication skills.
    • Demonstrated project and process management skills, with the ability to handle multiple vendors and multiple contracts as well as a wide range of tasks.
    • Intermediate working knowledge in Microsoft Office applications including Word, PowerPoint, and Outlook.
    • Basic working knowledge in Excel.

    Duties and Responsibilities

    • Direct and oversee all aspects of claims operations, in alignment with corporate goals and initiatives.
    • Ensure and communicate overall claims performance meets/exceeds Key Performance Indicators by evaluating, analyzing and interpreting data and metrics.
    • Ensure cross-functional collaboration and partnerships are developed and maintained in support of functional alignment.
    • Lead, manage, or direct and coordinate projects that directly impact claims operations.
    • Collect, analyze, and utilize data and feedback to identify opportunities to improve the relationship between the business and provider. This will include direct communication and participation with the Vendor Management Office (VMO) and Transformation Management Office (TMO).
    • Contribute to the ongoing design, development, and implementation of key core systems tied to claim operations processes.
    • Effectively collaborate with vendor to resolve claim issues/inquiries accurately at first contact from stakeholders.
    • Recruit, motivate, train, and develop staff within agreed policies and practices to maintain an effective workplace capable of meeting its objectives.
    • Perform all other miscellaneous responsibilities and duties as assigned or directed.

    #LI-Hybrid

  • 22 Days Ago

C
HI- 1099 Property Claims Adjuster
  • Copper Claims Services, Inc.
  • Honolulu, HI FULL_TIME
  • 1099 Property Claims Adjuster Copper Claims Services is a quickly growing independent loss adjusting firm based out of Irvine, CA. Copper Claims Services excels in providing custom claims solutions fo...
  • 28 Days Ago

M
Medical Office Manager
  • Medical office
  • Kailua, HI FULL_TIME
  • Experienced medical office manager needed to run our Primary Care office.You should demonstrate excellent organizational skills, be able to handle multiple tasks with personnel, patients, insurance is...
  • 25 Days Ago

H
Manager, Internal Ops Liaison, Claims
  • HMSA
  • Honolulu, HI FULL_TIME
  • Direct and oversee all aspects of claims operations, in alignment with corporate goals and initiatives. Ensure and communicate overall claims performance meets/exceeds Key Performance Indicators by ev...
  • 23 Days Ago

U
Quality Review Analyst NF-04
  • US Army Installation Management Command
  • Wheeler Army Airfield, HI FULL_TIME
  • Duties Supervision is general in nature. The working title for this position is Quality Assurance Officer. Identifies and evaluates financial asset management controls, determines the accuracy and com...
  • 14 Days Ago

P
Contract Review Broker
  • Pacific Image Properties
  • Honolulu, HI FULL_TIME
  • Do you enjoy contract reviews and helping agents? Would you like to earn some supplemental income? Pacific Image Properties is seeking a Contract Review Broker to add to our team. Compensation: $10,00...
  • 18 Days Ago

Filters

Clear All

  • Filter Jobs by companies
  • More

0 Medical Claims Review Manager jobs found in Honolulu, HI area

H
Remote Licensed Professional Counselor
  • Headway
  • Ewa Beach, HI
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/18/2024 12:00:00 AM

H
Remote Licensed Marriage and Family Therapist
  • Headway
  • Ewa Beach, HI
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/18/2024 12:00:00 AM

H
Remote Licensed Clinical Social Worker
  • Headway
  • Ewa Beach, HI
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/18/2024 12:00:00 AM

Q
Pediatric Anesthesiologist
  • QuarterLine Consulting Services
  • Honolulu, HI
  • Job Description Job Description Overview The lives of our nations active-duty military, veterans, and their families dep...
  • 4/15/2024 12:00:00 AM

W
Psychiatric Nurse Practitioner PMHNP - 95% Online/Remote
  • Wellness Partners Hawaii, Inc
  • Honolulu, HI
  • Job Description Job Description It is Wellness Partners Hawaii’s mission to provide accessible and quality mental health...
  • 4/15/2024 12:00:00 AM

W
Therapist - Psychologist, LCSW, LMFT, LMHC Online/Remote Work!
  • Wellness Partners Hawaii, Inc
  • Honolulu, HI
  • Job Description Job Description It is Wellness Partners Hawaii’s mission to provide accessible and quality mental health...
  • 4/15/2024 12:00:00 AM

H
Remote Licensed Psychiatric Nurse Practitioner
  • Headway
  • Ewa Beach, HI
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/15/2024 12:00:00 AM

H
Remote Licensed Psychiatrist
  • Headway
  • Ewa Beach, HI
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/15/2024 12:00:00 AM

Honolulu (/ˌhɒnəˈluːluː/; Hawaiian: [honoˈlulu]) is the capital and largest city of the U.S. state of Hawaiʻi. It is an unincorporated part of and the county seat of the City and County of Honolulu along the southeast coast of the island of Oʻahu.[a] The city is the main gateway to Hawaiʻi and a major portal into the United States. The city is also a major hub for international business, military defense, as well as famously being host to a diverse variety of east-west and Pacific culture, cuisine, and traditions. Honolulu is the most remote city of its size in the world and is the westernmost...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$101,475 to $129,382
Honolulu, Hawaii area prices
were up 1.9% from a year ago

Medical Claims Review Manager in Paramus, NJ
Support management with leading Medical Review team to ensure all types of claims requiring medical reviews are completed in compliance with State, Federal, accreditation standards and other applicable regulations.
February 01, 2020
Medical Claims Review Manager in Nashua, NH
By truly combining claims and bill review, the two systems are kept in sync utilizing the scheduled jobs of the aforementioned standard model; however, for real-time data updates, claims examiners are granted access to the entire live bill review system.
January 13, 2020
Medical Claims Review Manager in Davenport, IA
Complex claim errors can only be caught by physician reviewers with the clinical experience to spot mistakes that automated systems can’t detect.
January 03, 2020