Job summary
Job post source
This job is directly from HMSA
Job overview
The Case Resolution Specialist I at HMSA handles complex member and provider appeals, inquiries, and grievances to ensure compliance with policies, contracts, and regulations, impacting member satisfaction and operational efficiency.
Responsibilities and impact
The role involves analyzing and resolving sensitive cases, liaising with providers and members, participating in cross-departmental committees, proposing policy changes, assisting with audits and investigations, and ensuring quality assurance of case documentation.
Company overview
Hawaii Medical Service Association (HMSA) is a nonprofit health insurer in Hawaii, providing health plans to individuals, families, and businesses. They generate revenue through premiums paid by members and reimbursements from healthcare providers. Founded in 1938, HMSA is an independent licensee of the Blue Cross Blue Shield Association, ensuring access to a wide network of healthcare services. Their mission focuses on improving the health and well-being of Hawaii residents through innovative programs, community partnerships, and comprehensive healthcare solutions.
How to land this job
Position your resume to highlight your ability to conduct critical analysis of complex member and provider appeals, emphasizing your skills in applying policies, contractual provisions, and regulatory requirements relevant to healthcare.
Emphasize your experience in liaising between multiple stakeholders such as providers, members, and internal decision makers, showcasing your negotiation and conflict resolution skills.
Apply through multiple platforms including HMSA's corporate careers site and LinkedIn to maximize your application visibility and ensure your resume reaches the right recruiters.
Connect with current HMSA employees in the case resolution or member services divisions on LinkedIn; start conversations by referencing recent healthcare regulations or asking about their experience with member advocacy and appeals processes.
Optimize your resume for ATS by incorporating keywords from the job description such as 'case resolution,' 'member appeals,' 'regulatory compliance,' 'policy analysis,' and 'negotiation skills' to ensure it passes automated screenings.
Utilize Jennie Johnson's Power Apply feature to automate tailored applications across multiple sites and identify relevant LinkedIn connections, allowing you to focus your time on preparing for interviews and networking effectively.
Jennie Johnson works for you!
Here’s what we do to make sure you’re successful:
Targeted Resume Revamp:
We expertly craft your resume to navigate Applicant Tracking Systems (ATS) and showcase your qualifications, making you stand out as a top-tier candidate.
Job Description Dissection:
Unpack the job posting with expert analysis, ensuring your application hits every key requirement.
Bespoke Cover Letter:
Capture the attention of hiring managers with a personalized cover letter that highlights how your skills align perfectly with the job's needs.
Interview Mastery:
Prepare for interviews like a pro with likely questions, strategic answers, and insightful questions for you to ask, setting you apart as an informed candidate.
Direct Application Insights:
Receive tailored advice on the best places to apply, ensuring your applications are seen by the right employers.
Skills and Gaps Assessment:
Identify and close critical skills gaps to position yourself as the best-fit candidate for your ideal job.
Personalized Email Pitch:
Make a memorable first impression with an email template crafted to engage potential employers and initiate meaningful conversations.
In-depth Research Guide:
Leverage comprehensive research tools to gather effective insights on companies, industry trends, and role-specific challenges.
Detailed Company Analysis:
Gain in-depth understanding of your prospective employer, giving you the edge in applications and interviews.
Strategic Candidate Overview:
Understand your unique value and why companies would want to interview you, highlighting your background and positioning.