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Other Party Liability Examiner I (Honolulu or Kapolei)

at HMSA

Posted: 10/2/2019
Job Reference #: 5000329091406
Categories: Other/General
Keywords: online

Job Description

Employment Type

Full-time

Exempt or Non-Exempt

Non-exempt

Job Summary

Investigates all other party liability data (Coordination of Benefits between multiple plans or No Fault, Workers Compensation, Third Party Liability) to ensure accuracy and compliance with health plan administration and governmental rules and regulations.

Minimum Qualifications

  1. High school diploma or equivalent.
  2. One year of experience in a position dealing with the public.
  3. Effective written and verbal communication skills.
  4. Working knowledge of PC based windows programs
  5. Working knowledge of 10 key calculator.


 
 

Duties and Responsibilities

  1. 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.
  2. Routinely communicates via telephone with internal (public contact units) and external (other insurance carriers, provider staff, members, governmental regulatory agencies or attorneys) customers to obtain and/or provide information to resolve other partly liability issues/problems.
  3. Routinely composes correspondence directed to external customers to recover all erroneous benefit payments and/or resolving issues related to other party liability.
  4. Utilizes multiple references (desktop manuals, online databases, COB rules and regulations, or State and Federal rules and regulations, Independent Medical Evaluations (IME), Personal Injury Protection benefit forms, third party liability denials) in relation to appropriate claims processing for routine and complex levels of adjudication.