MAA Case Resolution Specialist

Make a difference in healthcare by helping people navigate complex challenges. Join a team dedicated to investigating and resolving member concerns, appeals, grievances, and complex service issues as a Case Resolution Specialist. In this role, you'll serve as an advocate for members, ensuring fair outcomes while collaborating with healthcare professionals, operational teams, and stakeholders across the organization.

Responsibilities

• Conduct detailed investigations into member appeals, grievances, complaints, and escalated service concerns.
• Review claims, authorizations, benefits, policies, call recordings, correspondence, and case histories to identify root causes and determine appropriate resolutions.
• Gather and analyze information from multiple departments and business partners to support case decisions.
• Research healthcare benefits, contractual language, and regulatory requirements related to member concerns.
• Act as a trusted resource and advocate by ensuring concerns are thoroughly investigated and resolved.
• Help members understand processes, benefits, and available options.
• Navigate sensitive situations with professionalism, empathy, and strong communication skills.
• Manage cases from intake through final resolution.
• Prepare written findings, resolution summaries, and correspondence.
• Coordinate corrective actions and collaborate with internal teams to improve member experiences.
• Identify recurring trends and recommend process improvements to prevent future issues.
• Maintain accurate case documentation and investigation records.
• Support audit readiness and compliance with applicable regulations.
• Participate in quality reviews, reporting activities, and continuous improvement initiatives.

Requirements

• Previous experience in customer service, healthcare operations, insurance, call center, claims, appeals, grievances, or administrative support.
• Strong critical thinking and analytical skills with the ability to investigate complex situations and determine appropriate solutions.
• Experience researching information, resolving issues, and making fact-based decisions.
• Excellent verbal and written communication skills.
• Ability to manage multiple priorities while maintaining attention to detail.

Qualifications

Preferred:

• Experience with healthcare payer or health insurance operations.
• Familiarity with membership appeals, grievances, claims, authorizations, or benefit administration.
• Case management experience.
• Knowledge of regulatory or compliance-driven environments.

Benefits

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

• Medical, dental & vision
• Critical Illness, Accident, and Hospital coverage
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

Pay

The pay range for this position is $23.33 - $23.33/hr. Individual compensation offered within this range will depend on qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.

Schedule

This is a fully onsite, contract position based in Honolulu, HI.