Who We Are

Lawelawe is a Native Hawaiian Owned Small Disadvantaged Business (NHO SDB) that specializes in providing a range of services to federal government clients, including program management, digital solutions, human capital and training, and medical staffing. Lawelawe leverages our NHO status to secure federal contracts that not only drive business success but also support our overall mission to uplift economically disadvantaged Native Hawaiian families and preserve the Native Hawaiian heritage.

Who You Are

An experienced, detail-oriented claims professional who can manage sensitive medical, financial, and legal information while helping a team deliver accurate and timely results. You are organized, dependable, comfortable working in multiple electronic systems, and able to guide coworkers, coordinate priorities, and identify issues requiring management attention. You communicate professionally and understand the importance of protecting private and sensitive information.

How You Will Make An Impact

You will support medical claims and healthcare cost recovery activities for a federal healthcare customer.  In addition to performing claims-examination duties, you will assist the Program Manager with workload distribution, daily workflow coordination, quality checks, and the scheduling of shared workstation usage. Your contributions will help the team maintain balanced workloads, meet deadlines, and recover healthcare costs owed to the Government.

Responsibilities

• Assist the Program Manager with distributing and balancing claims workloads based on case complexity, employee capacity, priorities, and deadlines.
• Monitor case progress, identify backlogs or workload imbalances, and recommend adjustments to the Program Manager.
• Coordinate shared workstation usage and the rotating on-site schedule under the Program Manager’s direction, communicating approved assignments and schedule changes to team members.
• Identify workstation scheduling conflicts, coverage gaps, and workspace constraints and elevate them to the Program Manager.
• Provide procedural guidance, peer training, and mentoring to Claims Examiners, including assistance with onboarding new team members.
• Maintain an assigned claims workload while performing lead-coordination responsibilities.
• Monitor shared organizational email inboxes and physical mail for incoming claims, correspondence, and inquiries.
• Process new referrals and establish Medical Affirmative Claims and Third-Party Collection case files.
• Enter claims and case information into ACMP and other required government systems.
• Maintain accurate electronic case files, tracking logs, correspondence, and supporting documentation.
• Research and collect authorized patient, beneficiary, treatment, billing, insurance, eligibility, and case-related information.
• Access medical, administrative, eligibility, and financial systems to obtain records, treatment timelines, billing statements, patient demographics, and related information.
• Verify patient and claim information and identify missing, inaccurate, or inconsistent data.
• Gather and organize medical records, accident reports, insurance information, billing data, and supporting documents for review.
• Properly name, index, upload, and maintain documents in SharePoint and government case-management systems.
• Record Third-Party Collection denial codes and payer responses.
• Complete standardized appeal templates and assemble appeal packages for higher-level review.
• Research potentially liable parties, insurance carriers, civilian attorneys, and other relevant entities.
• Prepare notices of claim using government-approved templates.
• Draft standard demand letters, settlement memoranda, and other routine correspondence for review and signature by authorized government personnel.
• Prepare and mail claims forms and supporting documentation when electronic submission is unavailable.
• Respond professionally to routine inquiries from insurance carriers, attorneys’ offices, healthcare organizations, government personnel, and other authorized parties.
• Provide approved, non-sensitive documentation in accordance with government direction.
• Update case status information within required timeframes.
• Track case milestones, correspondence, follow-up actions, payment activity, and statute-of-limitations deadlines.
• Perform data cleanup and first-level quality reviews of claims, reports, case files, and supporting documentation.
• Process cash collection vouchers and support the routing of recovered funds to the appropriate line of accounting.
• Verify payments, settlements, unpaid balances, and case status using authorized financial systems.
• Assist with collecting productivity, claims-processing, payment, and financial-recovery metrics for monthly reporting.
• Follow established standard operating procedures, quality control requirements, and supervisory direction.
• Perform other duties as assigned.

The Team

Lawelawe Training Services is an SBA Certified 8(a) Native Hawaiian Organization-Owned Small Disadvantaged Business specializing in services for federal government customers, including program management and business transformation, human capital and training, digital solutions, and medical staff support.

Here’s What You Need

• Three years of experience in medical claims, insurance claims, healthcare administration, billing, collections, case management, legal support, or a closely related field.
• At least one year of experience serving as a team lead, supervisor, senior specialist, or work coordinator, including assigning or coordinating work, monitoring progress, or mentoring coworkers. This experience may be included within the three years of relevant experience.
• Associate or bachelor’s degree in healthcare administration, business administration, paralegal studies, finance, insurance, or a related field is preferred.
• Demonstrated ability to balance workloads, track deadlines, and coordinate competing priorities across a team.
• Ability to coordinate shared workspace usage and hybrid-work schedules under the direction of the Program Manager.
• Ability to provide clear procedural guidance, review work for accuracy, and professionally identify issues requiring management attention.
• Experience reviewing and processing medical records, billing statements, insurance documentation, claims correspondence, payment records, or similar documents.
• Familiarity with healthcare billing, third-party collections, insurance denials, appeals, payment verification, or healthcare cost-recovery activities.
• Experience supporting a federal healthcare program, Department of Defense organization, federal agency, or government contractor is preferred.
• Strong attention to detail and the ability to accurately manage multiple electronic case files, deadlines, correspondence, and financial information.
• Experience working under established productivity, accuracy, timeliness, and quality-control requirements.
• Familiarity with ACMP, ABACUS, DEERS, GFEBS, JLV, MHS GENESIS, PEPR, SharePoint, or comparable healthcare and claims-management systems.
• Experience safeguarding HIPAA-protected records, PII, PHI, CUI, or other sensitive government information.
• Professional written and verbal communication skills and proficiency with Microsoft Word, Excel, Outlook, Teams, and SharePoint.
• Ability to work independently, follow detailed procedures, and learn multiple government claims, medical-record, eligibility, and financial systems.
• Public Trust or ability to successfully complete a government background investigation
• Must be a US Citizen

Benefits

• A competitive compensation package
• Comprehensive health and wellness benefits, including medical, dental, and vision plans
• Access to company-provided retirement savings options with matching contributions
• Opportunities for professional growth and continued learning
• Additional perks such as discounts on various services and products

The above job description is intended to describe the general nature and level of work being performed by individuals assigned to this position. It is not intended to be an exhaustive list of all responsibilities, duties, and skills required. Candidates possessing the necessary qualifications for the position will be considered.

Lawelawe Training Services Inc is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status, and will not be discriminated against on the basis of disability.

Offers of employment are contingent upon satisfactory completion of a comprehensive background verification, inclusive of a criminal record check. Employment may be subject to other background checks, as required by the position.