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Claims Liaison Coordinator

HMSA, Honolulu, HI, United States

Duration: Full Time


  1. Claims Resolution & Support


    • Serve as the primary liaison for complex escalated claim inquiries from providers, members, account management, and internal departments.

    • Research and resolve complex claim discrepancies, denials, adjustments, and payment issues within established service-level agreements (SLAs).

    • Coordinate with claims examiners, configuration, and payment integrity teams to ensure accurate claim adjudication.

    • Document and maintain claim processing instructions and workflows to ensure accurate and efficient processing.

    • Provide guidance and mentoring to Claims Liaison Specialists.



  2. Analysis & Reporting


    • Perform root-cause analysis of claim errors, payment delays, and provider/member complaints.

    • Compile and present findings to leadership with recommended solutions.

    • Track claim trends and prepare reports on recurring issues, financial impact, and compliance risks.



  3. Stakeholder Communication


    • Provide clear and timely communication of claim resolutions to providers, members, and internal stakeholders.

    • Develop strong working relationships with provider relations, customer service, utilization management, and network management teams.

    • Function as a subject-matter resource on claim workflows and policies.



  4. Process Improvement & Compliance


    • Identify opportunities to improve claims workflows, system configuration, and provider/member experience.

    • Participate in cross-functional workgroups to implement corrective actions and process enhancements.

    • Ensure adherence to state, federal, and accreditation guidelines (e.g., CMS, HIPAA, NCQA).



  5. Performs all other miscellaneous responsibilities and duties as assigned or directed.



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