Claims Specialist I

HMA is one of the nation's largest administrators of high-quality, innovative, and affordable health plans and distinctive services for self-funded organizations. Employers trust HMA's team of caring experts to protect two of their most important assets; their people and their health plan dollars.In 2021, HMA was chosen as a Washington's Best Workplaces by our Staff and PSBJ™, and in 2022 we were awarded one of Seattle's Best Places to Work by BuiltIn . Our vision, 'Proving What's Possible in Healthcare®,' and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results.What we are looking for: We are looking to hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team and helping others succeed, are motivated by tackling complex challenges, are courageous enough to share ideas, are action-oriented, are resilient, and are results-driven. What you can expect: You can expect an inclusive, flexible, and fun culture, comprehensive salary, benefits, and time off packages with plenty of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work/life balance, and the ability to contribute to something important, find out more about us at: https://www.accesshma.com/How YOU will make a Difference: The Claims Coordinator I is the subject matter expert supporting all Coordination of Benefits activities for HMA. Partners with management to administer coordination of benefits processing, resolution and related process improvements. This role will work collaboratively with a team and assist with setting and maintaining provider and customer pricing and coordination of benefits. Your role will be central in contributing to the overall operational excellence in the coordination of benefits and pricing of claims.What YOU will do:

• Customer and HMA Coordination of Benefits: As the SME, ensures that health plan payer hierarchy is maintained for HMA and RGA plans by identifying and maintaining all third party and coordination of benefits information through effective communication plans
• Coordination of Benefits: Verifies and maintains primary insurance coverage information: certifies potential primary insurance via telephone, on-line, and/or documents verification.
• Partners with Clients, Providers and other insurance including Medicare and Medicaid to resolve claim payments on behalf of our Members.
• Critical thinking and troubleshooting: Ability to identify issues, recommend solutions, and manage situations to resolution
• Process Improvement: Continually evaluates HMA Coordination of Benefits processes and documents to drive continuous improvement through internal and external feedback
• Customer and Provider relationship management: Quickly responds to and effectively manages claims pricing inquiries
• Business knowledge: Demonstrates operational business and claims pricing subject matter expertise
• Analysis & reporting: Prepares financial analysis reporting and summarizes findings for management
• Team oriented: Works well as part of a solutions team, sharing ideas, supporting intended outcomes
• Customer response: Effectively responds to internal and external customer inquiries and focuses on issue resolution

Knowledge, Experience, and Key Attributes needed for Success:

• 3+ years of claims processing and coordination of benefits experience
• Experience working with Tribal Health plans and/or Medicare a plus
• High school diploma, Associates Degree or equivalent required
• Strong interpersonal and communication skills
• Attention to detail, with high degree of accuracy and urgency
• Ability to take initiative and ownership of assigned tasks, working independently with minimal supervision, yet maintain a team-oriented and collaborative approach to problem solving
• Experience working with multiple systems and applications
• Demonstrated track record of success in a fast-paced environment

How we Support your Work, Life, and Wellness GoalsWe offer a comprehensive total rewards package including: competitive pay; annual incentive; medical, dental, and vision insurance; 401K retirement plan with match; generous PTO and holidays; an onsite gym facility; a gym subsidy; Life, AD&D, Short-Term and Long-Term Disability Insurances; an Employee Assistance Plan; free parking and easy freeway access to I-405 and I-520; a well-stocked kitchen on-site with subsidized snacks and refreshments; year-round wellness activities; the ability to earn a $500 wellness incentive; monthly events; paid volunteer hours and more!HMA requires a background screen prior to employment.Protected Health Information (PHI) Access Healthcare Management Administrators (HMA) employees may encounter protected health information (PHI) in the regular course of their work. All PHI shall be used and disclosed on a need-to-know-basis and according to HMA's standard policies and procedures.HMA is an Equal Opportunity Employer