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Claim processor jobs in Hawaii

- 15 jobs
  • Senior Claims Examiner, Property

    Archgroup

    Claim processor job in Hawaii

    With a company culture rooted in collaboration, expertise and innovation, we aim to promote progress and inspire our clients, employees, investors and communities to achieve their greatest potential. Our work is the catalyst that helps others achieve their goals. In short, We Enable Possibility℠. Position Summary Arch Insurance Group Inc., AIGI, has an opening with the Claims Division on the Mid Corp Property Team as a Senior Claims Examiner, Property. In this role, the responsibilities include actively managing complex First Party Commercial Property claims focused in Hawaii and other jurisdictions throughout the United States. This candidate will need to be local to Hawaii. Responsibilities Identify and assess coverage issues, draft coverage position letters, and retain coverage counsel, when necessary, as well as review coverage counsel's opinion letters and analysis Develop and implement strategy related to coverage issues which correlate with the overall strategy of matters entrusted to the handler's care Develop and implement timely and accurate resolution strategies to ensure mitigation of indemnity and expense exposures Maintain contact with any/all associated claims carrier(s)' claims staff, business line leader, underwriter, defense counsel, program manager, and broker to communicate developments and outcomes as necessary Investigate claims and review the insureds' materials, pleadings, and other relevant documents Identify and review each jurisdiction's applicable statutes, rules, and case law Review litigation materials including depositions and expert's reports Analyze and direct risk transfer, additional insured issues, and contractual indemnity issues Retain counsel when necessary and direct counsel in accordance with resolution strategy Analyze coverage, liability and damages for purposes of assessing and recommending reserves Prepare and present written/oral reports to senior management setting forth all issues influencing evaluations and recommending reserves Travel to and from locations within the United States to attend mediations, trials, and other proceedings relevant to the resolution of the matter Negotiate resolution of claims Select and utilize structure brokers Maintain a diary of all claims, post reserves in a timely fashion, and expeditiously respond to inquiries from the insured, counsel, underwriters, brokers, and senior management regarding claims Experience & Required Skills Exceptional communication (written and verbal), evaluating, influencing, negotiating, listening, and interpersonal skills to effectively develop productive working relationships with internal/external peers and other professionals across organizational lines Strong time management and organizational skills Demonstrated ability to take part in active strategic discussions Demonstrated ability to work well independently and in a team environment Hands-on experience and strong aptitude with Microsoft Excel, PowerPoint and Word Willing and able to travel 10% Education Bachelor's degree required. 5-7+ years of work experience at an insurance company and/or insurance claims loss adjustment service provider managing property claims process supporting commercial accounts Proper & active adjuster licensing in all applicable states, Hawaii #LI-SW1 #LI-REMOTE For individuals assigned or hired to work in the location(s) indicated below, the base salary range is provided. Range is as of the time of posting. Position is incentive eligible. $97,000 - $115,000/year Total individual compensation (base salary, short & long-term incentives) offered will take into account a number of factors including but not limited to geographic location, scope & responsibilities of the role, qualifications, talent availability & specialization as well as business needs. The above pay range may be modified in the future. Arch is committed to helping employees succeed through our comprehensive benefits package that includes multiple medical plans plus dental, vision and prescription drug coverage; a competitive 401k with generous matching; PTO beginning at 20 days per year; up to 12 paid company holidays per year plus 2 paid days of Volunteer Time Offer; basic Life and AD&D Insurance as well as Short and Long-Term Disability; Paid Parental Leave of up to 10 weeks; Student Loan Assistance and Tuition Reimbursement, Backup Child and Elder Care; and more. Click here to learn more on available benefits. Do you like solving complex business problems, working with talented colleagues and have an innovative mindset? Arch may be a great fit for you. If this job isn't the right fit but you're interested in working for Arch, create a job alert! Simply create an account and opt in to receive emails when we have job openings that meet your criteria. Join our talent community to share your preferences directly with Arch's Talent Acquisition team. 14400 Arch Insurance Group Inc.
    $97k-115k yearly Auto-Apply 18d ago
  • Coin Processor Driving

    Loomis 4.1company rating

    Claim processor job in Urban Honolulu, HI

    As a Coin Processor, you work with your team to maintain inventory in our cash vaults for our Loomis customers Responsibilities Count, sort, and handle coin bags weighing 50 pounds Manage the proper storage of pallets of boxed coin Previous forklift experience preferred (though not required) Requirements * Repetitiously lift, without assistance, at least 50 pounds from floor level to 3-4 foot level * Ability to move bulk coin with hand carts or manual pallet jacks * A valid firearms permit and/or ability to pass all applicable firearms and state regulated security guard card/license requirements in the state to which you are applying is required. This may include varying requirements under applicable state law (e.g., some states require an individual to have a high school diploma or GED to be eligible for a state issued security guard card/license or equivalent) Working Conditions * Work in a large area within a vault with little or no exposure to outside light * Full-time schedule can potentially consist of an average of 40 to 50 hours/week, with a minimum of 5 days during a 6-day period Essential Functions/Job QualificationsAs part of the qualification process for the Coin Processor position, a Human Performance Evaluation (HPE) is required. This evaluation requires successful completion of testing in the following areas:Lift:- 25lbs vertical lift from 10 inches to 66 inches from the floor (1X) Lift-Carry:- 18lbs vertical lift from 1 inch to 44 inches from the floor, and horizontally transfer 15ft (4X)- 18lbs vertical lift from 10 inches to 36 inches from the floor and horizontally transfer 300ft (1X)- 50lbs vertical lift from 10 inches to 36 inches from the floor and horizontally transfer 2ft (2X) Push-Pull:- Horizontally transfer 47lbs of force on a sled (single, non-dominant arm), a distance of 1ft (2X) Repetitive Coupling:- Squeeze Jamar Hand Dynamometer requiring forces up to 30lbs / both right & left hands (4X each) Benefits Loomis offers one of the most comprehensive employees benefit packages in the industry, which includes: * Vacation and Sick Time (PTO) as well as Paid Holidays * Health & Dental Insurance * Vision Insurance * 401(k) Plan * Basic Life Insurance Plan * Voluntary Life Insurance Plan * Flexible Spending and Health Savings Account * Dependent Care Account Industry leading Training and Development
    $31k-35k yearly est. 4d ago
  • Claims Investigator - Part Time

    Coventbridge Group 3.8company rating

    Claim processor job in Hawaii

    Claims Investigator (Part-Time) Oahu, HI area Immediate need for a PT Claims Investigator within the largest worldwide investigative solutions company. Join CoventBridge Group as it continues its expansion into all areas of investigations, allowing continual growth for its employees. Responsibilities/ Requirements Responsibilities: Duties and responsibilities include essential functions of positions assigned to this classification. Depending on assignment, the employee may perform a combination of some or all the following duties: Ability to conduct multiple types of complex claims investigations Daily submission of updates regarding work performed on each case Ability to manage time Maintain a sufficient level of client billable hours Write and record detailed statements Conduct scene investigations Submit professional and client ready investigative reports Conduct background/activity checks and courthouse research Due to driving, constant state of alertness in a safe manner is an essential function of this position Requirements: Licensed or eligible to be licensed as a Private Investigator in Hawaii and in surrounding states 1 year or more of full time report writing experience on field investigations cases Field investigations experience - face to face statements Ability and willingness to travel within a multi-state coverage area (as necessary) Experienced in investigation of product/auto/general liability claims, Workers Compensation, disability claims, life insurance and contestable death claims Flexibility to work varied/irregular hours and days including nights, weekends Reliable and fuel efficient vehicle with minimum of auto liability insurance Possess or is willing to purchase: digital recording device and laptop computer with Windows Operating System with access to Microsoft Word and other necessary equipment for position Educational/Experience Qualifications: Associate or Bachelor's Degree in Criminal Justice or related field Experience as a Private Investigator or detective Military or Law Enforcement background Comprehensive knowledge of insurance law and underwriting Self-starter who holds themselves accountable for results and performance Strong attention to detail with commitment to accuracy and quality Ability to adapt and work under stressful and sensitive situations Can type 50 words or more a minute Benefits CoventBridge offers the most premiere compensation package in the industry. Flexibility to self-schedule Ability to work from home-based office Competitive pay Monthly vehicle allowance Company fuel card Company cell phone Company matching 401(k) Travel and report writing compensation Company paid investigator licensing fees Paid ongoing career advancement training Timely expense reimbursement with very minimal out-of-pocket expenses The salary range for this role is $27 - $31 per hour. This is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, geographic location, performance, and business or organizational needs. About Us: CoventBridge Group is the global leader in full-service investigations providing: Surveillance, SIU and Compliance, Claims Investigation, Counter-Fraud Programs, Desktop Investigations, Social Media, Record Retrieval, Canvasses and Vendor Management programs. The company provides top tier data privacy and security practices, deploys robust case management technology customized to clients' needs and delivers worldwide coverage via its 1000 employees and affiliates worldwide. CoventBridge is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, caste, disability, veteran status, and other legally protected characteristics and maintains a drug-free workplace. CoventBridge is committed to the full inclusion of all qualified individuals. As part of this commitment, CoventBridge will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact: Human Resources; ************; *******************************. CoventBridge (USA) Inc. Hawaii License # PDA-1099
    $27-31 hourly Auto-Apply 60d+ ago
  • Claims Representative (IAP) - Workers Compensation Training Program

    Sedgwick 4.4company rating

    Claim processor job in Urban Honolulu, HI

    By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Claims Representative (IAP) - Workers Compensation Training Program Are you looking for an impactful job requiring no prior experience that offers an opportunity to develop a professional career? + A stable and consistent work environment in an office setting. + A training program to learn how to help employees and customers from some of the world's most reputable brands. + An assigned mentor and manager who will guide you on your career journey. + Career development and promotional growth opportunities through increasing responsibilities. + A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs. **PRIMARY PURPOSE OF THE ROLE:** To be oriented and trained as new industry professional with the ability to analyze workers compensation claims and determine benefits due. **ARE YOU AN IDEAL CANDIDATE?** We are seeking enthusiastic individuals for an entry-level trainee position. This role begins with a comprehensive 6-week classroom-based professional training program designed to equip you with the foundational skills needed for a successful career in claims adjusting. Over the course of a few years, you'll have the opportunity to grow and advance within the field. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE** + Attendance and completion of designated classroom claims professional training program. + Performs on-the-job training activities including: + Adjusting lost-time workers compensation claims under close supervision. May be assigned medical only claims. + Adjusting low and mid-level liability and/or physical damage claims under close supervision. + Processing disability claims of minimal disability duration under close supervision. + Documenting claims files and properly coding claim activity. + Communicating claim action/processing with claimant and client. + Supporting other claims examiners and claims supervisors with larger or more complex claims as assigned. + Participates in rotational assignments to provide temporary support for office needs. **QUALIFICATIONS** Bachelor's or Associate's degree from an accredited college or university preferred. **EXPERIENCE** Prior education, experience, or knowledge of: - Customer Service - Data Entry - Medical Terminology (preferred) - Computer Recordkeeping programs (preferred) - Prior claims experience (preferred) Additional helpful experience: - State license if required (SIP, Property and Liability, Disability, etc.) - WCCA/WCCP or similar designations - For internal colleagues, completion of the Sedgwick Claims Progression Program **TAKING CARE OF YOU** + Entry-level colleagues are offered a world class training program with a comprehensive curriculum + An assigned mentor and manager that will support and guide you on your career journey + Career development and promotional growth opportunities + A diverse and comprehensive benefits offering including medical, dental vision, 401K, PTO and more _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is 25.65/hr. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. #claims #claimsexaminer #entrylevel #remote #LI-Remote_ Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
    $38k-45k yearly est. 12d ago
  • Cash & Coin Vault Processor

    Bank of Hawaii 4.7company rating

    Claim processor job in Urban Honolulu, HI

    Under the direction of the Manager, this position provides quality service and support to internal and external customers by processing transactions, answering questions, responding to inquiries and service requests in a timely and professional manner while adhering to Vault Services & Operations (VSO) standard safety requirements. High School diploma or G.E.D. Level is dependent on years of experience and size/complexity of prior positions held. Minimum 2 years in banking, cash handling, accounting or related experience. Demonstrated proficiency with personal computers in a networked environment and Microsoft applications (Outlook, Word, Excel, and PowerPoint) or similar software. Knowledge of or ability to use Bank software and systems. Ability to independently operate required equipment after training period. Demonstrated verbal and written communication skills. Analytical ability and math skills sufficient to balance cash trucks. Able to work independently with frequent interruptions. Must have effective interpersonal skills with a positive, can-do attitude focused on teamwork and partnership. Must be able to lift/transport up to 50 pounds and be able to stand for extended periods of time. Able to work flexible hours, including weekends and shift work. As a Bank of Hawaii employee, you ensure (or assist with ensuring) compliance with applicable laws, regulations, regulatory requirements and Bank policies and procedures, including but not limited to those related to Fair Banking, Anti-Money Laundering laws and regulations, Bank Secrecy Act and USA PATRIOT Act. Delivering exceptional customer experiences is at the heart of what we do at Bank of Hawaii. We listen, understand and deliver what our customers need to help them build a better tomorrow. We are an EEO/AA employer, including disability and veterans. For Bank of Hawaii's full EEO statement, please visit **************************** Provides quality service and support in a professional manner, meeting the bank's service guarantees/standards by processing (receives, verifies and balances) deposits received from customers and branches and releases orders to armored couriers. Prepares outgoing cash orders for customers and branches. Fields all communications via telephone, email, fax, or mail including customer deposit discrepancy notifications, customer inquiries and disputes and researches and resolves problems and processes customer requests. Balances cash trucks and adheres to cash handling guidelines. Assists with various validation processes, as assigned by VSO management. Ensures daily bag and reconciliation is balanced, reviewed, and completed accurately within established timeframes. Provides team support in meeting team goals and daily deadlines. Works with teammates, to maintain current working knowledge of the various functions within the department. Performs other miscellaneous job responsibilities and duties as assigned.
    $32k-36k yearly est. Auto-Apply 60d+ ago
  • Benefit and Claims Analyst

    Highmark Health 4.5company rating

    Claim processor job in Urban Honolulu, HI

    This job is a non-clinical resource that coordinates, analyzes, and interprets the benefits and claims processes for clinical teams and serves as a liaison between various departments across the enterprise, including but not limited to, Clinical Strategy, Sales/Client Management, Customer Service, Claims, and Medical Policy. The person in this position must fully understand all product offerings available to Organization members and be versed in claims payment methodologies, benefits administration, and business process requirements. **ESSENTIAL RESPONSIBILITIES** + Coordinate, analyze, and interpret the benefits and claims processes for the department. + Serve as the liaison between the department and the claims processing departments to facilitate care/case management activities and special handling claims. Communicate benefit explanations clearly and concisely to all pertinent parties. + Investigate benefit/claim information and provide technical guidance to clinical and claims staff regarding the final adjudication of complex claims. Research and investigate conflicting benefit structures in multi-payor situations. + Provide prompt, thorough and courteous replies to written, electronic and telephonic inquiries from internal/external customers (e.g., clinical, sales/marketing, providers, vendors, etc.) Follow-up on all inquiries in accordance with corporate and regulatory standards and timeframes. + Must have the ability to apply knowledge about the business operations of the area within the defined scope of the job. Assess benefit limitations in accordance with Medical Policy Guidelines. + Monitor and identify claim processing inaccuracies. Bring trends to the attention of management. + Assist with handling inbound calls and strive to resolve customer concerns received via telephone or written communication. + Work independently of support, frequently utilizing resources to resolve customer inquiries. + Collaborate with Clinical Strategy, Sales/Client Management and other areas across the enterprise to respond to client questions and concerns about care/case management and high-cost claimants. + Gather information and develop presentation/training materials for support and education. + Other duties as assigned or requested. **EDUCATION** **Required** + High School or GED **Substitutions** + None **Preferred** + Associate's degree in or equivalent training in Business or a related field **EXPERIENCE** **Required** + 3 years of customer service, health insurance benefits and claims experience. + Working knowledge of Highmark products, systems (e.g., customer service and clinical platforms, knowledge resources, etc.), operations and medical policies + PC Proficiency including Microsoft Office Products + Ability to communicate effectively in both verbal and written form with all levels of employees **Preferred** + Working knowledge of medical procedures and terminology. + Complex claim workflow analysis and adjudication. + ICD9, CPT, HPCPS coding knowledge/experience. + Knowledge of Medicare and Medicaid policies **LICENSES or CERTIFICATIONS** **Required** + None **Preferred** + None **SKILLS** + Knowledge of principles and processes for providing customer service. This includes customer needs assessment, meeting quality standards for services + Knowledge of administrative and clerical procedures and systems such as managing files and records, designing forms and other office procedures + The ability to take direction, to navigate through multiple systems simultaneously + The ability to interact well with peers, supervisors and customers + Understanding the implications of new information for both current and future problem-solving and decision-making + Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate and not interrupting at inappropriate times + Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems + Ability to solve complex issues on multiple levels. + Ability to solve problems independently and creatively. + Ability to handle many tasks simultaneously and respond to customers and their issues promptly. **Language (Other than English):** None **Travel Requirement:** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ **_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ **Pay Range Minimum:** $21.53 **Pay Range Maximum:** $32.30 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J273827
    $21.5-32.3 hourly 4d ago
  • Claims Investigator-Adjustor - SR-23

    County of Hawaii (Hi 4.2company rating

    Claim processor job in Hilo, HI

    Investigates, adjusts, and negotiates for settlement of claims of real and personal property damage for and against the County of Hawai'i; conducts investigative work in contemplation of litigation and anticipated cases; handles personal injury cases not covered by insurance carried by the County of Hawai'i; and performs other related duties as required. There is one (1) immediate temporary full-time not-to-exceed 11/30/2028 vacancy with the Office of the Corporation Counsel - Litigation Division in Hilo. The eligible list may be used for other permanent and temporary vacancies as they arise during the life of the list. Temporary appointment may lead to conversion to permanent appointment. Examples of Duties * Determines, evaluates, and verifies the facts set forth in any claim or lawsuit filed against and by the County. * Locates, interviews, and interrogates the principals involved and/or the witnesses. * Inspects the physical evidence of damages; gathers and verifies the value of damages by asking for expert opinions when necessary; arrives at judgments of the worth of statements given by individuals. * Obtains additional, clarifying, or substantiating information, evidence, and facts. * Prepares reports on findings with recommendations. * Negotiates for the settlement of claims to the satisfaction of the principals involved. * Recommends to the Corporation Counsel the acceptance or rejection of liability by the County or action to be taken against individuals who owe the County. * Checks with the appropriate agencies to determine the assets of individuals against whom the County has claim. * Follows up on delinquent accounts by personal interview and recommends new terms or enforcement of terms based on findings. * Assists the County attorneys in the presentation of cases. * Testifies and presents supporting information in court, arbitrations, mediations, hearings, administrative hearings or any other quasi-judicial proceedings. * Assists the County attorneys in presenting evidence and producing witnesses. * As directed, works with County commissions, boards, administrators, and others in judicial or quasi-judicial hearings. * Monitors and evaluates all requests for No-Fault benefits, including medical treatment plans for compliance with appropriate laws and guidelines; recommends the approval or disapproval of payments, treatment plans, or modifications to plans. * Notifies claimant or authorized representative when No-Fault benefits are about to be or have been exhausted. * Locates missing persons. * Investigates complaints against County of Hawai'i employees. * Prepares detailed reports of investigations, analyses, findings, and recommendations; prepares other administrative reports as required. * Serves complaints, counter and/or cross claims, warrants, subpoenas, summonses, or other documents for the Office of the Corporation Counsel. * Investigates hardship cases in condemnation proceedings and workers' compensation cases. * Performs other related duties as assigned. Minimum Qualification Requirements Training and Experience: A combination of education and experience substantially equivalent to: * graduation from an accredited college or university with a baccalaureate degree (scan and attach a copy of your official transcript to your application), and * three (3) years of investigational or law enforcement work, of which * one (1) year shall have involved the investigation or the adjustment of claims relating to personal, medical, and property damages, and * possession of a valid State of Hawai`i driver's license (Class 3) or any other valid comparable driver's license at time of filing. (You will be required to submit your valid driver's license at time of hire.) Note: Foreign transcripts must be accompanied by an official credential evaluation report to determine U.S. equivalency. (Scan and attach a copy of your official credential evaluation report to your application.) Examination: All applicants who meet the minimum qualification requirements will be assigned a score of 70 points. An education and experience evaluation will be conducted based on the applicant's training, education and experience as presented in the application. Please read the minimum qualification requirements carefully. Be certain to list all pertinent training and experience, as this may be important in determining your examination score. It is essential that the applicant describe fully the duties and responsibilities of each position held, specify the date of each position held (from and to, month and year), and indicate the number of hours worked per week. Attach all required documentation (e.g. official transcript, professional license(s)/certification(s), DD-214, etc.) at the time of submitting your application. Note: In-person interviews and/or further testing in Hawai'i County may be required at the discretion of the hiring department/agency. If in-person interviews and/or further testing are required, applicants who are referred to the hiring department/agency must be available to participate in person and at their own expense at that phase of the selection process. Knowledge of: principles and practices of investigation; interviewing and interrogating methods and techniques; rules of evidence; elementary law of real property, insurance, and torts; court procedures; human relations and behavior. Ability to: interpret and apply laws and regulations; gather, analyze, and evaluate facts and settle liabilities; make sound observations and mature judgments; deal tactfully and effectively with the public and representatives of other government agencies; write accurate, clear, and concise reports. Physical Requirements: Persons seeking appointment to positions in this class must meet the health and physical condition standards deemed necessary and proper to perform the essential functions of the position with or without reasonable accommodations. Physical Effort Grouping: Light Benefits of County employment: The County of Hawai'i offers a competitive compensation package. Your total compensation is comprised of your salary and a generous range of valuable benefits, subject to eligibility requirements. * Flexible Working Arrangements: Options may include alternate work schedules (4-10) and flexible working hours. (Not all Departments/Agencies participate and not all positions are eligible.) * Vacation: Start accruing paid vacation time immediately upon hire - up to 21 days per year. * Sick Leave: Start accruing paid sick leave time immediately upon hire - up to 21 days per year. * Holidays: The County provides 13 paid holidays per year (plus General Election Day when applicable). * Training and Development: The County has a variety of training and development opportunities for employees. * County Tuition Reimbursement Program: This scholarship program rewards employees who take the initiative to advance their education and learning. * Public Service Loan Forgiveness (PSLF) Program: You may be eligible for this federal program which forgives portions of federal student loans for individuals working in public service. * Retirement Plan: The Employees' Retirement System is a qualified defined benefit public pension plan that provides retirement, disability, survivor and other benefits to all eligible full-time and part-time county employees in the State of Hawaii as well as their beneficiaries. * Deferred Compensation: Save additional money for retirement - this voluntary supplemental retirement savings plan allows for the investment of tax-deferred contributions. * Flexible Spending Plan: Use pre-tax dollars to pay for qualified dependent care and/or medical expenses, as well as insurance premiums. * Health Benefit Plans: The County of Hawai'i offers a variety of health benefit plans for eligible employees. * Employee Assistance Program (EAP): This voluntary assistance program provides employees and their family members with free professional and confidential assistance in overcoming personal and work-related problems. * Group Life Insurance: Free life insurance policy for active employees. * Credit Union Membership * Other Leaves: You may be eligible for other leaves, including Family Leave, Funeral Leave, Leave Sharing, Military Leave, Donor Leave, Victims Protection Leave, as well as leave for Parent-Teacher Conferences, Disaster Relief, Blood Bank Donations, and Jury Duty. All benefits are subject to eligibility requirements and change due to legislative actions and/or changes negotiated through collective bargaining. Please check out the benefits tab for additional information. Supplemental Information Please scan and attach these supporting documents to your on-line application, if required: * an official college transcript, * a valid driver's license, * a temporary assignment verification, * professional licenses, and/or * certificates. Veterans applying for veteran's preference points shall also scan and attach their DD-214 form and as needed, their VA claim letter to the on-line application. PLEASE APPLY IMMEDIATELY AS THIS RECRUITMENT MAY CLOSE AT ANY TIME. ELECTRONIC NOTIFICATION TO APPLICANTS: Please ensure that the email address and mobile phone number you provide is current, secure, and readily accessible to you. We will not be responsible in any way if you do not receive our emails and text messages or fail to check your email box or NEOGOV account INBOX in a timely manner. Checking your NEOGOV account INBOX daily is recommended and is the most secure method to check on notices sent to you. This is a new feature created by our vendor, NEOGOV. Please add *********************** to your contact list. Open your NEOGOV account using your user name and password. In the upper right hand corner of the account is your name, and under your name, click on INBOX to view all notices sent you. The notices will appear here in the INBOX even in the event you don't receive it on your cell phone, computer, or other electronic device. This is the best way to check and view all notices sent to you. You will receive a confirmation email upon successfully submitting your application. Failure to receive this confirmation email, indicates that your application was not submitted. APPLICATIONS MUST BE FILED ONLINE AT: *************************************************** E-mail: *********************
    $47k-53k yearly est. Easy Apply 13d ago
  • Processor

    Hilo Products, Inc.

    Claim processor job in Hilo, HI

    Job Description Job Title: Processor Job Summary: The processor is responsible for inspecting, cleaning, cutting, and packaging fresh fruits and vegetables to create safe, high-quality, customer-ready products while strictly adhering to food safety standards and production schedules. Duties and Responsibilities: Prepare, wash, peel, and slice fruits and vegetables per standard operating procedures. Assemble finished produce items such as salads, trays, or cut components and then seal, label, and package them for shipment. Ensure product consistency and quality, verifying weights and presentation of packages. Maintain sanitation and safety by keeping the work area, tools, and equipment clean, and following food safety guidelines. Operate machines and equipment safely as trained and support other production areas as needed. Qualifications: Previous experience in fresh produce processing is preferred but not required Strong knife skills, attention to detail, and ability to follow instructions accurately. Comfortable working in refrigerated environments and standing for long periods. Able to work weekends and holidays as needed. Great communication skills and a team player. Benefits (for those who qualify): Free Medical, Drug, Vision, Dental, through HMSA or Kaiser and HDS. Low-cost visits for Chiropractic, Acupuncture, and Massage. Voluntary Benefits such as HealthCare FSA, Dependent Care FSA, AFLAC Voluntary Insurance, and Transamerica Life Insurance. Employee perks include discounts on select businesses and services. 401k with company match. Paid Time Off. Employee Assistance Program. Hilo Products Inc. is an equal opportunity employer. The Company strictly prohibits and does not tolerate any discrimination towards applicants based on race, color, religion, creed, ethnicity, ancestry, national origin, citizenship, veteran or military status, sexual orientation, marital status, age, physical or mental disability, or any other protected factor under federal, state or local law.
    $30k-38k yearly est. 19d ago
  • Senior Claims Examiner, Property

    Arch Capital Group Ltd. 4.7company rating

    Claim processor job in Hawaii

    With a company culture rooted in collaboration, expertise and innovation, we aim to promote progress and inspire our clients, employees, investors and communities to achieve their greatest potential. Our work is the catalyst that helps others achieve their goals. In short, We Enable Possibility℠. Position Summary Arch Insurance Group Inc., AIGI, has an opening with the Claims Division on the Mid Corp Property Team as a Senior Claims Examiner, Property. In this role, the responsibilities include actively managing complex First Party Commercial Property claims focused in Hawaii and other jurisdictions throughout the United States. This candidate will need to be local to Hawaii. Responsibilities * Identify and assess coverage issues, draft coverage position letters, and retain coverage counsel, when necessary, as well as review coverage counsel's opinion letters and analysis * Develop and implement strategy related to coverage issues which correlate with the overall strategy of matters entrusted to the handler's care * Develop and implement timely and accurate resolution strategies to ensure mitigation of indemnity and expense exposures * Maintain contact with any/all associated claims carrier(s)' claims staff, business line leader, underwriter, defense counsel, program manager, and broker to communicate developments and outcomes as necessary * Investigate claims and review the insureds' materials, pleadings, and other relevant documents * Identify and review each jurisdiction's applicable statutes, rules, and case law * Review litigation materials including depositions and expert's reports * Analyze and direct risk transfer, additional insured issues, and contractual indemnity issues * Retain counsel when necessary and direct counsel in accordance with resolution strategy * Analyze coverage, liability and damages for purposes of assessing and recommending reserves * Prepare and present written/oral reports to senior management setting forth all issues influencing evaluations and recommending reserves * Travel to and from locations within the United States to attend mediations, trials, and other proceedings relevant to the resolution of the matter * Negotiate resolution of claims * Select and utilize structure brokers * Maintain a diary of all claims, post reserves in a timely fashion, and expeditiously respond to inquiries from the insured, counsel, underwriters, brokers, and senior management regarding claims Experience & Required Skills * Exceptional communication (written and verbal), evaluating, influencing, negotiating, listening, and interpersonal skills to effectively develop productive working relationships with internal/external peers and other professionals across organizational lines * Strong time management and organizational skills * Demonstrated ability to take part in active strategic discussions * Demonstrated ability to work well independently and in a team environment * Hands-on experience and strong aptitude with Microsoft Excel, PowerPoint and Word * Willing and able to travel 10% Education * Bachelor's degree required. * 5-7+ years of work experience at an insurance company and/or insurance claims loss adjustment service provider managing property claims process supporting commercial accounts * Proper & active adjuster licensing in all applicable states, Hawaii #LI-SW1 #LI-REMOTE For individuals assigned or hired to work in the location(s) indicated below, the base salary range is provided. Range is as of the time of posting. Position is incentive eligible. $97,000 - $115,000/year * Total individual compensation (base salary, short & long-term incentives) offered will take into account a number of factors including but not limited to geographic location, scope & responsibilities of the role, qualifications, talent availability & specialization as well as business needs. The above pay range may be modified in the future. * Arch is committed to helping employees succeed through our comprehensive benefits package that includes multiple medical plans plus dental, vision and prescription drug coverage; a competitive 401k with generous matching; PTO beginning at 20 days per year; up to 12 paid company holidays per year plus 2 paid days of Volunteer Time Offer; basic Life and AD&D Insurance as well as Short and Long-Term Disability; Paid Parental Leave of up to 10 weeks; Student Loan Assistance and Tuition Reimbursement, Backup Child and Elder Care; and more. Click here to learn more on available benefits. Do you like solving complex business problems, working with talented colleagues and have an innovative mindset? Arch may be a great fit for you. If this job isn't the right fit but you're interested in working for Arch, create a job alert! Simply create an account and opt in to receive emails when we have job openings that meet your criteria. Join our talent community to share your preferences directly with Arch's Talent Acquisition team. 14400 Arch Insurance Group Inc.
    $97k-115k yearly Auto-Apply 18d ago
  • Coin Processor Driving

    Loomis 4.1company rating

    Claim processor job in Lihue, HI

    As a Coin Processor, you work with your team to maintain inventory in our cash vaults for our Loomis customers Responsibilities Count, sort, and handle coin bags weighing 50 pounds Manage the proper storage of pallets of boxed coin Previous forklift experience preferred (though not required) Requirements * Repetitiously lift, without assistance, at least 50 pounds from floor level to 3-4 foot level * Ability to move bulk coin with hand carts or manual pallet jacks * A valid firearms permit and/or ability to pass all applicable firearms and state regulated security guard card/license requirements in the state to which you are applying is required. This may include varying requirements under applicable state law (e.g., some states require an individual to have a high school diploma or GED to be eligible for a state issued security guard card/license or equivalent) Working Conditions * Work in a large area within a vault with little or no exposure to outside light * Full-time schedule can potentially consist of an average of 40 to 50 hours/week, with a minimum of 5 days during a 6-day period Essential Functions/Job QualificationsAs part of the qualification process for the Coin Processor position, a Human Performance Evaluation (HPE) is required. This evaluation requires successful completion of testing in the following areas:Lift:- 25lbs vertical lift from 10 inches to 66 inches from the floor (1X) Lift-Carry:- 18lbs vertical lift from 1 inch to 44 inches from the floor, and horizontally transfer 15ft (4X)- 18lbs vertical lift from 10 inches to 36 inches from the floor and horizontally transfer 300ft (1X)- 50lbs vertical lift from 10 inches to 36 inches from the floor and horizontally transfer 2ft (2X) Push-Pull:- Horizontally transfer 47lbs of force on a sled (single, non-dominant arm), a distance of 1ft (2X) Repetitive Coupling:- Squeeze Jamar Hand Dynamometer requiring forces up to 30lbs / both right & left hands (4X each) Benefits Loomis offers one of the most comprehensive employees benefit packages in the industry, which includes: * Vacation and Sick Time (PTO) as well as Paid Holidays * Health & Dental Insurance * Vision Insurance * 401(k) Plan * Basic Life Insurance Plan * Voluntary Life Insurance Plan * Flexible Spending and Health Savings Account * Dependent Care Account Industry leading Training and Development
    $31k-35k yearly est. 4d ago
  • Claims Examiner - General Liability | Hawaii License Required

    Sedgwick Claims Management Services, Inc. 4.4company rating

    Claim processor job in Urban Honolulu, HI

    By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Claims Examiner - General Liability | Hawaii License Required Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? * Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. * Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world's most respected organizations. * Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. * Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights. * Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. * Enjoy flexibility and autonomy in your daily work, your location, and your career path. * Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. OFFICE LOCATIONS Hybrid 2 Days In-Office PRIMARY PURPOSE: To analyze complex or technically difficult general liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. ESSENTIAL FUNCTIONS and RESPONSIBILITIES * Analyzes and processes complex or technically difficult general liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. * Assesses liability and resolves claims within evaluation. * Negotiates settlement of claims within designated authority. * Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. * Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level. * Prepares necessary state fillings within statutory limits. * Manages the litigation process; ensures timely and cost effective claims resolution. * Coordinates vendor referrals for additional investigation and/or litigation management. * Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. * Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. * Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner. * Communicates claim activity and processing with the claimant and the client; maintains professional client relationships. * Ensures claim files are properly documented and claims coding is correct. * Refers cases as appropriate to supervisor and management. QUALIFICATION Education & Licensing Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Experience Five (5) years of claims management experience or equivalent combination of education and experience required. Skills & Knowledge * Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business. * Excellent oral and written communication, including presentation skills * PC literate, including Microsoft Office products * Analytical and interpretive skills * Strong organizational skills * Good interpersonal skills * Excellent negotiation skills * Ability to work in a team environment * Ability to meet or exceed Service Expectations TAKING CARE OF YOU * Flexible work schedule. * Referral incentive program. * Career development and promotional growth opportunities. * A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $80,000 - $90,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. #Claims #ClaimsExaminer #Hybrid #LI-Hybrid #LI-Remote #LI-AM1 Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.
    $80k-90k yearly Auto-Apply 46d ago
  • Claims Processor II

    Medimpact Healthcare Systems 4.8company rating

    Claim processor job in Urban Honolulu, HI

    Exemption Status:United States of America (Non-Exempt)$17.92 - $22.85 - $27.78 “Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.” This position is not eligible for Sponsorship. MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team! Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare. At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution! Job Description Summary The successful candidate will work as a member of the Claims Processing team, ensuring accurate and timely processing of Physician, Facility, Dental, and Vision claims for multiple plan designs, including traditional PPO plans, Reference Based Pricing (RBP) plans, and Minimal Essential Coverage (MEC) plans. Interprets schedules of benefits and plan documents to apply accurate benefits to claims according to the plan design. Applies internal policy and procedures for claims adjudication, identifies and resolves claim processing errors, adjusts previously processed claims, and logs refunds for claim overpayments. Performs data entry of CMS 1500, UB 04, and dental claims, research claim issues, and assists in audit projects. Works under general supervision, relying on instructions, work process guidelines, policies & procedures, and company knowledge/experience to perform job functions, with supervision ranging from close to minimal oversight based on demonstrated skill and performance levels. Essential Duties and Responsibilities include the following. Other duties may be assigned. Accurate and timely processing of Physician, Facility, Dental and Vision claims for multiple plan designs, including traditional PPO plans, Reference Based Pricing (RBP) plans and Minimal Essential Coverage (MEC) plans. Adhere to Corporate and Departmental standards including production and quality goals. Interpret schedule of benefits and plan documents to apply accurate benefits to claims according to the plan design. Identify potential system or plan design issues that would impact the correct adjudication of a claim. Effectively communicate with the Management team on claim processing questions and issues. Interpretation and application of internal policy and procedures for claims adjudication. Identify and resolve the root cause of a claim processing and/or data entry error. Adjust previously processed claims. Identify claim over payments and log refunds. Data entry of CMS 1500, UB 04, and dental claims. Research complex claim issues. Assist in audit projects Supervisory Responsibilities No supervisory responsibilities Client Responsibilities This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written). One must be able to; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients. Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience GED/HS Diploma and 1+ year experience or equivalent combination of education and experience Computer Skills Intermediate knowledge of MS Office/Word, Excel, PowerPoint and Outlook. Experience with Windows based database programs is preferred. Strong aptitude for new programs. Certificates, Licenses, Registrations Certified Claims Professional (CCP), Medical Billing and Coding Certificate, or Certified Professional Coder (CPC) not required but highly preferred. Other Skills and Abilities Demonstrated ability to appear for work on time, follow directions from a supervisor, interact well with co-workers, understand and follow work rules and procedures, comply with corporate policies, goals and objectives, accept constructive criticism, establish goals and objectives, and exhibit initiative and commitment. Reasoning Ability Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Mathematical Skills Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations. Ability to add and subtract two digit numbers and to multiply and divide with 10's and 100's. Ability to perform these operations using units of American money and weight measurement, volume, and distance. Language Skills Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization. Competencies To perform the job successfully, an individual should demonstrate the following competencies: Composure Decision Quality Organizational Agility Problem Solving Customer Focus Drive for Results Peer Relations Time Management Dealing with Ambiguity Learning on the Fly Political Savvy Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is regularly required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This position may regularly be exposed to or encounter moving mechanical parts, high, precarious places, fumes or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration. The noise level in the work environment is usually moderate (examples: business office with computers and printers, light traffic). Work Location This position must work on-site at the Honolulu, Hawaii location for purposes of providing adequate support to internal clients; being available for face-to-face interactions and coordination of work with other employees, colleagues, clients, or vendors; as well as for facilitation of quick and effective decisions through collaboration with stakeholders. Remote work is not an option for these purposes. Working Hours This is a full-time non-exempt position requiring one to be able to work overtime from time to time in order to get the job done. Therefore, one must have the ability to work nights, weekends or on holidays as required. This may be changed at any time to meet the needs of the business. The typical working hours for this position are Monday through Friday from 8:00am to 5:00pm. Travel This position requires no travel however attendance may be required at various local conferences and meetings. The Perks: Medical / Dental / Vision / Wellness Programs Paid Time Off / Company Paid Holidays Incentive Compensation 401K with Company match Life and Disability Insurance Tuition Reimbursement Employee Referral Bonus To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to ************************* MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego, California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets. Equal Opportunity Employer, Male/Female/Disabilities/VeteransOSHA/ADA: To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Disclaimer: The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.
    $27.8 hourly Auto-Apply 6d ago
  • Claims Processor

    Hawaii Dental Service 4.6company rating

    Claim processor job in Urban Honolulu, HI

    Under the supervision of Claims Supervisor, performs accurately all functions related to dental claims processing. Follows processing rules, guidelines, and policies. Meets department productivity, quality, and accountability standards. ESSENTIAL DUTIES AND RESPONSIBILITIES Key Responsibilities Electronically images hardcopy claims batch as OCR, Non-OCR, and x-ray attachments. Batch image paper attachments, POAs and adjustments, and back-end imaging of claims documentation. Inputs rejected and RFI claims notices. Performs all aspects of claims data entry, including verification of required documentations. Processes Levels 1, 2 and 3 claims consisting of single, COB-S, Dual, Pre-authorizations and out of state type claims. Reviews all levels of suspended electronic claims including opening and sorting of ECS mails. Processes requests to pay pre-authorizations. Other Duties and Responsibilities Assists the Claims department in adhering to established document policies and procedures. Provides back-up support and assistance in Customer Service and other departments as necessary. Accomplishes special projects as assigned. Determines and follows through with a plan to meet annual goals set up with the supervisor. Takes responsibility for relationships with others in the department and company. Works as a team player and assists wherever there is a need. Maintains a customer advocate attitude, understanding the importance that timely and accurate claims processing has on customer satisfaction. Other miscellaneous duties and responsibilities as assigned. MINIMUM QUALIFICATIONS AND EXPERIENCE Education High School Diploma or its equivalent required. Experience Minimum two years of clerical experience, customer service, sales, or any combination of education and experience which would provide the necessary knowledge, skills, and abilities to meet the minimum qualifications to perform the essential functions of this position. Skills and Knowledge Working knowledge of PC applications (i.e., word processing and spreadsheets) highly desirable. Requires demonstrated customer service skills and sales ability. Ability to maintain focus and attention to detail. Ability to handle multiple tasks with some distractions. Ability to communicate orally and in writing with all levels of staff, customers and vendors. Ability to handle all information in a confidential manner and in compliance with federal and state laws/regulations (i.e., HIPAA, PHI). Note : The above information in this description has been designed to indicate the general nature and level of work performed by an employee in this classification. It is not to be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications of employees assigned to this job. Hawaii Dental Service has the right to add to, revise, or delete information in this description. Reasonable accommodation will be made to enable qualified individuals with disabilities to perform the essential functions of this position.
    $28k-36k yearly est. Auto-Apply 60d+ ago
  • Claims Examiner - General Liability | Hawaii License Required

    Sedgwick 4.4company rating

    Claim processor job in Urban Honolulu, HI

    By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Claims Examiner - General Liability | Hawaii License Required Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? + Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. + Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world's most respected organizations. + Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. + Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights. + Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. + Enjoy flexibility and autonomy in your daily work, your location, and your career path. + Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. **ARE YOU AN IDEAL CANDIDATE?** We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. **OFFICE LOCATIONS** Hybrid 2 Days In-Office **PRIMARY PURPOSE** : To analyze complex or technically difficult general liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Analyzes and processes complex or technically difficult general liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. + Assesses liability and resolves claims within evaluation. + Negotiates settlement of claims within designated authority. + Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. + Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level. + Prepares necessary state fillings within statutory limits. + Manages the litigation process; ensures timely and cost effective claims resolution. + Coordinates vendor referrals for additional investigation and/or litigation management. + Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. + Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. + Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner. + Communicates claim activity and processing with the claimant and the client; maintains professional client relationships. + Ensures claim files are properly documented and claims coding is correct. + Refers cases as appropriate to supervisor and management. **QUALIFICATION** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. **Experience** Five (5) years of claims management experience or equivalent combination of education and experience required. **Skills & Knowledge** + Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business. + Excellent oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Analytical and interpretive skills + Strong organizational skills + Good interpersonal skills + Excellent negotiation skills + Ability to work in a team environment + Ability to meet or exceed Service Expectations **TAKING CARE OF YOU** + Flexible work schedule. + Referral incentive program. + Career development and promotional growth opportunities. + A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in_ _this job posting only, the range of starting pay for this role is $80,000 - $90,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._ \#Claims #ClaimsExaminer #Hybrid #LI-Hybrid #LI-Remote #LI-AM1 Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
    $80k-90k yearly 46d ago
  • Claims Specialist

    Kelly Services 4.6company rating

    Claim processor job in Urban Honolulu, HI

    **NOW HIRING: Temp-to-Hire Claims Specialist - Dental Agency (Honolulu, HI)** **Now Hiring: Claims Specialist** **Pay Rate:** $19/hr **Schedule:** Monday - Friday, 8 AM - 5 PM **Type:** Temp to Hire Opportunity Join a reputable dental agency in Honolulu as a Claims Specialist! Under the supervision of the Claims Supervisor, you'll perform essential functions related to dental claims processing. This role requires adherence to claims processing rules, guidelines, and policies, while consistently meeting departmental standards for productivity and quality. **Essential Duties and Responsibilities** + Complete all aspects of claims data entry, including documentation verification + Digitally image hardcopy claims, x-rays, and related attachments + Adjudicate dental claims in accordance with HDS rules and guidelines + Process coordination of benefit claims **Other Duties and Responsibilities** + Assist the Claims department with adherence to established document policies and procedures + Provide back-up support for Customer Service and other departments as needed **Minimum Qualifications and Experience** + **Education:** High School Diploma required; post-high school training in data processing, office management, business, or a related field preferred + **Experience:** 1-2 years of related clerical, data entry, accounting, or claims processing experience, or an equivalent combination of education, experience, and training; dental office or dental claims processing experience preferred **Skills and Knowledge** + Working knowledge of PC applications (word processing and spreadsheets highly desirable) + Demonstrated customer service skills and sales ability + Strong attention to detail and ability to maintain focus + Ability to multitask despite distractions + Effective oral and written communication skills for all levels of staff, customers, and vendors + Ability to maintain confidentiality and comply with laws and regulations (e.g., HIPAA, PHI) **How to Apply** Once you apply, you'll proceed to the next steps if your skills and experience match the role. Even if this position isn't a fit, you remain in our network-giving other recruiters access to your profile and expanding your opportunities. We are committed to helping you discover what's next in your career. **Apply today!** We look forward to meeting you and helping you take the next step in your career journey! As part of our promise to talent, Kelly supports those who work with us through a variety of benefits, perks, and work-related resources. Kelly offers eligible employees voluntary benefit plans including medical, dental, vision, telemedicine, term life, whole life, accident insurance, critical illness, a legal plan, and short-term disability. As a Kelly employee, you will have access to a retirement savings plan, service bonus and holiday pay plans (earn up to eight paid holidays per benefit year), and a transit spending account. In addition, employees are entitled to earn paid sick leave under the applicable state or local plan. Click here (********************************************************************* for more information on benefits and perks that may be available to you as a member of the Kelly Talent Community. Trust the office staffing pioneer. Finding the right job isn't always easy. Kelly Professional & Industrial takes the guesswork out of your job search by connecting you with great opportunities that work for you. That means your schedule, your interests, and your career plan. In fact, our company created the staffing industry with the goal of connecting people with great office jobs-so you could say we're pretty good at it! About Kelly Work changes everything. And at Kelly, we're obsessed with where it can take you. To us, it's about more than simply accepting your next job opportunity. It's the fuel that powers every next step of your life. It's the ripple effect that changes and improves everything for your family, your community, and the world. Which is why, here at Kelly, we are dedicated to providing you with limitless opportunities to enrich your life-just ask the 300,000 people we employ each year. Kelly is committed to providing equal employment opportunities to all qualified employees and applicants regardless of race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, age, marital status, pregnancy, genetic information, or any other legally protected status, and we take affirmative action to recruit, employ, and advance qualified individuals with disabilities and protected veterans in the workforce. Requests for accommodation related to our application process can be directed to the Kelly Human Resource Knowledge Center. Kelly complies with the requirements of California's state and local Fair Chance laws. A conviction does not automatically bar individuals from employment. Kelly participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. Kelly Services is proud to be an Equal Employment Opportunity and Affirmative Action employer. We welcome, value, and embrace diversity at all levels and are committed to building a team that is inclusive of a variety of backgrounds, communities, perspectives, and abilities. At Kelly, we believe that the more inclusive we are, the better services we can provide. Requests for accommodation related to our application process can be directed to Kelly's Human Resource Knowledge Center. Kelly complies with the requirements of California's state and local Fair Chance laws. A conviction does not automatically bar individuals from employment.
    $19 hourly 3d ago

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