Research Coordinator

HMSA • Honolulu, HI

1d • Hybrid

About The Position

1. Coordinates case resolution with internal business areas to respond timely
and accurately to provider inquiries regarding claims, benefits and medium
complex issues that include medical, or payment policy questions and
provider appeals. Resolve root problems to ensure compliance with contract
terms and servicing goals. Communicates directly with providers and office
staff to develop case information and communicate issue resolution. Issues
researched and resolved are of medium complexity.
2. Participates on cross department workgroups representing Provider Services
Department. Identifies impacts to providers and communicates the provider's
perspective to internal business areas. Coordinates system issue resolution
and is responsible to facilitate internal and external communications about
core system changes and issues. Develops business requirements and test
cases to validate system changes and upgrades meet business requirements.
3. Develops education and training material for providers and their staff
including workshop presentations and written educational material.
Coordinates content development with other business areas and gains business
approval. Coordinates and develops provider communications to ensure
information is available to providers timely and accurately.
4. Coordinates and maintains Provider Servicing staff training program. Train
new employees and supplements training with ongoing guidance and mentoring
to research and field staff. Develop and maintain success measurement
activities that support department goals.
5. Develops, implements and maintains Department workflows and procedures.
Identifies and participates in process improvements for greater operational
efficiency.
6. Performs all other miscellaneous responsibilities and duties as assigned or
directed.

Requirements

• Bachelor's (degree and two years related work experience; or an equivalent combination of education and related work experience.
• Effective verbal and written communication skills.
• Basic working knowledge of Microsoft Office applications including but not limited to Word and Outlook/Email.

Responsibilities

• Coordinates case resolution with internal business areas to respond timely and accurately to provider inquiries regarding claims, benefits and medium complex issues that include medical, or payment policy questions and provider appeals.
• Participates on cross department workgroups representing Provider Services Department.
• Develops education and training material for providers and their staff including workshop presentations and written educational material.
• Coordinates and maintains Provider Servicing staff training program.
• Develops, implements and maintains Department workflows and procedures.
• Performs all other miscellaneous responsibilities and duties as assigned or directed.

What This Job Offers

• Job Type: Full-time
• Number of Employees: 501-1,000 employees