Claims Adjudicator

Job Title: Claims Adjudicator

Industry: Healthcare

Duration: Temporary

Hours: Monday - Friday, 7:00-4:00, 7:30-4:30 or 8:00-5:00 and Fridays will be the same start time but ending one hour earlier

Location: Honolulu, HI

Parking: Not Provided

Pay Rate: 17.00/Hour

This organization is local health insurer that has been serving the health and wellness needs for Hawaii for over 30 years. They are one of the largest health insurers in the state and continue to provide exceptional benefits, one - on - one personalized services, flexibility and choices for Hawaii’s businesses. They also offer great benefits, growth and advancement within their company!

Description:

• Processes claims according to Plan documents while applying Company policies and procedures.

• Verifies data entered from the claim form is accurate and complete to enable the claim to be processed correctly.

• Prioritizes workload to ensure performance objectives and competencies are met or exceeded.

• Accesses and utilizes all available resources to perform required functions.

• Improves claim payment accuracy by identifying pricing and/or submission inconsistencies to management.

• Performs duties with productivity and accuracy levels set by management reflective of the types and complexity of

claims processed.

• Ensures that Federal and State regulations, timeliness standards, confidentiality requirements, and accreditation

standards are met

• Runs third - party liability (TPL) diary reports and other claim reports.

• Efficiently processes the following types of claims:

• • Professional claims

  • TPL claims

  • Previously denied claims

  • Travel reimbursements

  • Dental claims

  • Basic Coordination of Benefits (COB)

• Must comply with Company and Departmental policies and procedures.

• Performs other duties as assigned.

• Must be present in the office to perform the job functions, except for external meetings and events or unless authorized to work from home

• Job may be modified at any time.

• In office training and remote work is subject to approval at a later date

Requirements:

• Basic proficiency in Microsoft Word and Excel

• Knowledge of medical terminology, CPT, ICD, and HCPCS codes

• Good organizational and decision - making skills

• Able to prioritize and consistently meet deadlines

• Strong data entry skills and attention to detail

• 10-key by touch

• Type at least 30 wpm

• Work independently and in a team environment

• Meet or exceed performance objectives and competencies

• Read and comprehend reference materials and documents related to health insurance such as plan documents and procedure manuals

• Apply commonsense understanding to carry out instructions furnished in written, oral, or diagram form

• Deal with problems involving several concrete variables in standardized situations

• Calculate figures and amounts by adding, subtracting, multiplying, and dividing

• No license or certification required

• High School diploma or GED required

• Certificate from college or technical school, three months of experience in medical claims processing at a health insurance company or third-party administrator, or equivalent combination of education and experience is preferred

ID# 1569020

All offers are contingent upon the successful completion of fingerprint background and reference checks. In addition, the following health screens are required:

• Must show proof of being fully vaccinated against COVID-19 unless a reasonable accommodation is approved. If partially vaccinated, or approved for a vaccine exemption, employees must comply by submitting weekly negative test results from an approved COVID-19 test (PCR or NAAT).

Interested Applicants: Please visit us online at www.staffingsolutionsofhawaii.com to view additional positions.  Applications will only be reviewed for applicants currently living in the state of Hawaii and who are available for an interview with Staffing Solutions. #SSOH

Why work with Staffing Solutions of Hawaii:

• We are a local, award winning, and growing privately owned agency in business for 25 years

• Employees enjoy competitive pay, stimulating careers, and excellent growth opportunities!

• We have over 120 job positions including full-time, part-time, and internship opportunities inclusive with medical benefits options

• We partner with 100+ organizations in Hawaii, such as Kaiser Permanente, Bank of Hawaii, Hawaiian Airlines, Hilton Grand Vacations, KHON 2 News and many more!

We are proud to be an Equal Employment Opportunity and Affirmative Action employer, including females, minorities, protected Veterans and those with disability.