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:

  • Provider/member eligibility

  • 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

Minimum Qualifications:

  • 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.

EEO/AA/Disability/Vets Employer