Claims Liaison Coordinator

Job Summary

Hybrid Work Environment - Must reside in Hawaii
Pay Range: $53,000 - $99,000
Note: Individuals typically begin between the minimum to middle of the pay range

Duties And Responsibilities

• 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.
• Analyze and report on claim errors, payment delays, and provider/member complaints.
• Track claim trends and prepare reports on recurring issues, financial impact, and compliance risks.
• Communicate clear and timely 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.
• 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).

Minimum Qualifications

• Associates degree and three years of related work experience; or equivalent combination of education and related work experience.
• Effective written and verbal communication skill, including the ability to communicate and present complex issues in a concise and easy to understand manner.
• Knowledge of process improvement methodologies.
• Knowledge of methodologies for driving increased operational quality.
• Intermediate knowledge of Microsoft Office applications including, but not limited to Word, Powerpoint, Outlook and Excel.