Hawaii Medical Service Association Other Party Liability Examiner II in Honolulu, Hawaii
Company:Hawaii Medical Service Assn.Job Title:Other Party Liability Examiner IIExempt or Non-Exempt:Non-ExemptIsland:OahuCity:HonoluluLocation:HonoluluEmployment Type:Full TimeJob Summary:Independently investigates all other party liability data (Coordination of Benefits between multiple plans, and No Fault, Workers Compensation, Third Party Liability) to ensure accuracy and compliance with health plan administration and governmental rules and regulations.Duties and Responsibilities:
Investigates and determines health plan benefit responsibility for all lines of business where potential other party liability exists. Utilizes system data bases and transactions to release or adjust claims.
Routinely communicates via telephone with internal (public contact units) and external (other insurance carriers, provider staff, members, governmental regulatory agencies and attorneys) customers to obtain and/or provide information to resolve other partly liability issues/problems.
Routinely composes business correspondence directed to external customers to recover all erroneous benefit payments and/or resolving issues related to other party liability.
Utilizes multiple references (desktop manuals, online databases, COB rules and regulations, State and Federal rules and regulations, Independent Medical Evaluations (IME), Personal Injury benefit forms, third party liability denials) in relation to appropriate claims processing for routine & complex adjudication.
Other duties as assigned.
Associate degree or equivalent and 2 years of experience in a position dealing with the public or equivalent combination of education and experience
Effective written and verbal communication skills
Working knowledge of PC based windows programs
Working knowledge of 10 key calculator