FEP Benefit Processor / CSR II

HMSA
United States, Hawaii, Honolulu
818 Ke’eaumoku Street (Show on map)
Oct 24, 2024
Perform accurate benefit administration determinations on standard and complex claims processing scenarios that meet accuracy and timelines standards. Concurrently utilize multiple local HMSA and FEP Director's Office and Operations Center systems and resources to research and resolve claims processing deferrals and adjustments. Effectively apply sound claims processing decisions that deliver high quality customer-centric delivery of service. Collaborate with intra-department team and internal departments that support FEP benefit and claims processing activities such as Medical Management, Customer Relations and Finance & Accounting to ensure consistent delivery of information and services. Identify problematic issues in policy or process that result in unintended negative consequences for the Member or Provider. Promptly present case details, recommend solutions, and/or corrective action to management to minimize unfavorable customer impact. Deliver accurate and timely responses to eligibility, benefit and basic/complex claims status inquiries using multiple systems and resources to research information (i.e., QNXT, Documentum, 837 Database, Mainframe, ASSIST, FEPDirect, FEPBlue.org, BlueWeb.org, PC software). Exhibit advanced ability to respond verbally, in person and in writing to internal and external customer's inquiries on enrollment, eligibility, benefits and claims adjudication questions in a professional, accurate and timely manner. Active and engaged participation in test claim creation and validation efforts to ensure the proper processing outcomes and compliance with local HMSA and FEP Operations Center system upgrades and / or enhancements. Performs all other miscellaneous responsibilities and duties as assigned or directed.