Job Description: Applies appropriate medical necessity criteria from established medical policies and clinical... practice guidelines to apply concurrent review determinations as described in the Medical Management UM work plan...
specific eligibility, benefit and provider requirement for selected service(s) based on member's primary line of business... validation of member specific eligibility, benefit and provider requirement for selected service(s) based on member's primary...
Job Description: Prioritizes approved invoices and check requests according to payment terms. Familiarizes with company policies and navigating steps in Dynamics GP, Certify and CentreSuite. Verifies approver's level of authority to ensu...
to service excellence. Effectively and independently analyze and research inquiries from customers (internal and external... to their needs quickly and efficiently. Requires broad understanding of HMSA's business, including the Hawaii Health Connector, HMSA...
;or an equivalent combination of education and work experience. Experience in analysis and planning. Working knowledge of Hawaii...
Job Description: Oversee daily cash positioning, concentration, and funding/settlement across HMSA legal entities. Support oversight of corporate banking and financial institution relationships, primarily related to treasury, cash manage...
. Conduct and/or supervise live call monitoring and recorded interaction reviews to evaluate service quality, policy compliance... training, or process improvements. Support a culture of continuous learning, accountability, and service excellence. * Analyze...
Job Description: Strategic planning and project management Develop and contribute to strategic communications plans to ensure the delivery of meaningful, clear, concise, relatable messaging that supports HMSA's goals and initiatives....
Job Description: Lead and manage AI/Automation development, machine learning, data engineering, and automation delivery teams. Set strategic direction, delivery priorities, architecture guardrails, and development standards for AI an...
, to encourage members to attend regular provider appointments and utilize medical services that support their health.Engage... with members and their families to discuss major health concerns and explore solutions to obstacles impacting service delivery...