Health Insurance Operations Director jobs in Hawaii

Health Insurance Operations Director directs and oversees health insurance operations programs in multiple service areas, including account installation, implementation, client support, contract administration, claim processing, and enrollment and eligibility. Manages vendors assigned to each operation. Being a Health Insurance Operations Director resolves issues within each service area. Has deep knowledge of health insurance operations. Additionally, Health Insurance Operations Director typically requires a bachelor's degree of business administration or its equivalent. Typically reports to top management. The Health Insurance Operations Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be a Health Insurance Operations Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)

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Health Care Services Specialist II
  • UHA Health Insurance
  • Honolulu, HI FULL_TIME
  • JOIN UHA’S TEAM

    We focus on your health and pay 100% for your family's medical insurance and provide 20 days of paid personal time off during your first year!

    Health Care Services Specialist II

    Department: Health Care Services

    Salary level: 3

    Position Summary
    • Conduct administrative functions for the Health Care Services Administration team; and to serve as a backup with any other duties needed
    • Provide general administration support to the Health Care Services department (ie: management, clinical & data analytics teams)
    • Maintain and follow department policy and procedures as required
    • Maintain and ensure URAC standards, criteria, and guidelines
    Essential Duties & Responsibilities
    • Handle inbound and outbound telephone calls (ie: prior authorization status inquiries, research of ICD, CPT, & HCPCS codes)
    • Discuss inquiries with other staff and/or departments to resolve any issues
    • Request additional clinical notes as needed
    • Retrieve messages from the telephone answer service and add messages to the Voicemail Spreadsheet
    • Assist with non-clinical review of prior authorizations, data entry, and proper process for clinical review
    • Retrieve electronic files/faxes
    • Assign to the appropriate staff, prior authorization file and/or designated folder
    • Open, scan and distribute mail
    • Coordinate meetings and conference calls by confirming availability of all participants as well as availability of conference room or offsite facility
    • Electronic filing of completed member records and/or any other miscellaneous documentation
    • Process and distribute HCS Daily Reports to the HCS clinical & non-clinical staff
    • Process incoming drug request overrides (via phone or fax) by determining validity of the request; if not sent to the PBM
    • Process & distribute the daily Inpatient Hospital Census Report to the clinical team
    • Acquire hospital discharges daily
    • Serve as a backup to HCS Specialist III to generate all administrative team letters (ie Approvals, Denials, Partials, LOIs, etc)
    • Generate and process the Invalid Seen Date report
    • Update the system as necessary or return the file to the proper HCS staff to make corrections
    • Assist with the creation, updating and revising of Health Care Services educational materials as necessary, including PowerPoints or other materials
    • Accurately maintain and update department policies and procedures, performing Quality Control (QC) reviews as necessary
    • Perform other duties and/or projects as assigned by the HCS Supervisor or management
    • Request for additional duties or to be crossed trained in other duties when workload permits
    • This Position prohibits any activity that requires interpretation of clinical information to customers, including the choosing of a set of criteria to use for handling a request for healthcare services or treatment
    Required Education And Experience

    To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
    • Two years of previous administrative or clerical experience, preferably in a health care related setting
    • High School diploma or equivalent
    Preferred And Advanced Qualifications
    • Associates degree from an accredited university/college
    • CPC (Certified Professional Coder) designation is desired
    • Administrative or clerical experience in a health care related setting
    Physical Demands/Working Conditions

    The work environment characteristics described here are representative of those associate encounters while performing the essential functions of this job.
    • Requires frequent standing, sitting, stooping, walking, seeing, hearing, speaking
    • Wearing of headsets required when answering phones
    • This position is eligible to work from home and will rotate with team to work in the office to complete administrative tasks
    Competitive Compensation & Excellent Benefits Offered

    Visit our website at https://uhahealth.com/page/career-opportunities to apply and for details about vacant positions.

    An Equal Opportunity Employer
  • 3 Days Ago

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Director of Operations
  • Marriott International
  • Koloa, HI FULL_TIME
  • Job Number 24077408Job Category Rooms & Guest Services OperationsLocation Sheraton Kauai Resort, 2440 Hoonani Road, Koloa, Hawaii, United States VIEW ON MAPSchedule Full-TimeLocated Remotely? NRelocat...
  • 7 Days Ago

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Director of Operations
  • Kahuli Leo Lea
  • Kaneohe, HI FULL_TIME
  • POSITION TITLE: Director of Operations REPORTS TO: Executive/Creative Director STATUS: Full-time/Exempt (1.0 FTE) SALARY RANGE: $80,000-$95,000 benefits THE ORGANIZATION: K?huli Leo Le?a is a 501(c)(3...
  • 11 Days Ago

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Director of Operations
  • Prince Dance Institute
  • Kamuela, HI PART_TIME
  • Who we are: Prince Dance Institute was founded in 2004 to bring performing arts training and opportunities to the students on the Big Island. We are a dance and performing arts school based in the bea...
  • 2 Months Ago

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Director of Behavioral Health
  • Kalihi Palama Health Center
  • Honolulu, HI FULL_TIME
  • Primary Purpose: The purpose of this position is to oversee the delivery of behavioral health services for Kalihi-Palama Health Center (KPHC). The incumbent is responsible for managing day to day oper...
  • 11 Days Ago

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RN Care Specialist I
  • UHA Health Insurance
  • Honolulu, HI FULL_TIME
  • JOIN UHA’S TEAMWe focus on your health and pay 100% for your family's medical insurance and provide 20 days of paid personal time off during your first year!RN Care Specialist IDepartment: Health Care...
  • 3 Days Ago

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Corporate Director of Resident Experience
  • Maplewood Senior Living LLC
  • Westport, CT
  • Corporate Director of Resident Experience Want to know what makes our employees eager about going to work every day? The...
  • 6/2/2024 12:00:00 AM

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Director of Residence Experience
  • Inspir Embassy Row, LLC
  • Washington, DC
  • Job Title: Director of Resident Experience Location: Washington D.C. Employment Type: Full-Time Salary Range: $75,000 - ...
  • 6/2/2024 12:00:00 AM

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Producer, MC22 - Located in Dubuque, IA
  • Mediacom Communications Corporation
  • Dubuque, IA
  • Located in Dubuque, IA Position: Producer, MC22 Who we are: Since 1995, Mediacom Communications has become a coast-to-co...
  • 6/2/2024 12:00:00 AM

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Shift Supervisor: Supported Living Services
  • Wingspan Care Group
  • Shaker Heights, OH
  • Lifeworks is a nonprofit organization dedicated to ensuring that individuals with autism lead healthy and enriched lives...
  • 6/2/2024 12:00:00 AM

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Residential Autism Program Director
  • Wingspan Care Group
  • Shaker Heights, OH
  • Now offering $5000 Sign on Bonus! Take the reins. Build your team. Inspire and innovate. Grow professionally. Those are ...
  • 6/2/2024 12:00:00 AM

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Part time-Preschool Sport and Fitness Coach
  • Super Soccer Stars
  • Annapolis, MD
  • The JumpBunch coach is essential to our success as an organization. As the most visible aspect of the program, the coach...
  • 6/2/2024 12:00:00 AM

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Strategic Account Manager - Remote
  • AssistRx
  • Orlando, FL
  • The Senior Account Manager cultivates and maintains AssistRx's relationship with our Pharmaceutical manufacturing partne...
  • 6/2/2024 12:00:00 AM

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Strategic Account Manager - Remote
  • AssistRx
  • Tampa, FL
  • The Senior Account Manager cultivates and maintains AssistRx's relationship with our Pharmaceutical manufacturing partne...
  • 6/2/2024 12:00:00 AM

Hawaii (/həˈwaɪi/ (listen) hə-WY-ee; Hawaiian: Hawaiʻi [həˈvɐjʔi]) is the 50th and most recent state to have joined the United States, having received statehood on August 21, 1959. Hawaii is the only U.S. state located in Oceania, the only U.S. state located outside North America, and the only one composed entirely of islands. It is the northernmost island group in Polynesia, occupying most of an archipelago in the central Pacific Ocean. The state encompasses nearly the entire volcanic Hawaiian archipelago, which comprises hundreds of islands spread over 1,500 miles (2,400 km). At the southea...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Health Insurance Operations Director jobs
$181,223 to $244,400