Hawaii Medical Service Association Claims Examiner I (BlueCard Host) in Honolulu, Hawaii
Company:Hawaii Medical Service Assn.Job Title:Claims Examiner I (BlueCard Host)Exempt or Non-Exempt:Non-ExemptIsland:OahuCity:HonoluluLocation:HonoluluEmployment Type:Full TimeJob Summary:Develop the basic knowledge and skills required to effectively process routine and regular claims and claim inquiries submitted through the BlueCard Unit which administers inter-plan (Blue plan to Blue plan) processing.A BlueCard Home examiner processes claims and inquiries for HMSA (Blue Cross Blue Shield of Hawai‘i) members receiving medical services outside the State of Hawai‘i.Duties and Responsibilities:
Successfully complete on the job training in the following areas:
Basic claims processing:
Basic payment and reimbursement policies for Host processing, or medical, reimbursement, and benefit policies for Home processing
COB processing – interpret COB values submitted to accurately pass data for Host processing, or coordinate and apply benefits for Home processing
Use of systems, reference databases (e.g. provider or membership), applications and tools to research claims questions and inquiries
Resolution of routine system and adjudication edits using HMSA internal claims systems.
BlueCard specific training:
BlueCard Program, processing standards, policies, inter-plan processing requirements and resources.
Use if ITS and Blue2 systems which specifically supports inter-plan processing. Knowledge of ITS specific coding structure, data values, system transactions and the requirements of each unique transaction to support the different types of claims processing and communications between plans.
Prioritization of work to meet Inter-plan Performance measures
Via the Blue2 system or emails, initiate or respond to contacts with other Blue plans to resolve claims inquiries, or requests
As needed, via simple/routine verbal or written communication:
Coordinate with internal departments
Contact providers’ offices or other Blue Plans
Perform other duties as assigned:
Innovation, process improvement activities
Complete or participate in corporate training, compliance certification or initiatives as directed by management
High school diploma and one year of work experience or equivalent combination of education and work experience.
Good verbal and written communications skills.
Basic working knowledge of standard office equipment, PC and Microsoft Office programs
Overtime may be required to meet business needs. Hours may include weekends and holidays.