Claims Analyst

We are now hiring ambitious, motivated Claim Analysts to work in our team focused, premier healthcare navigation business. In this role, you will be leveraging acquired knowledge to deliver high quality customer interactions that are consultative and lead to better healthcare outcomes. Through this role, you will have the opportunity to positively impact the lives of employee customers and their families, while driving increased benefit satisfaction and reducing healthcare spend for their employers.

We Offer You

A competitive total rewards package, continuing education & training, and tremendous potential with a growing worldwide organization:

• A full Benefits Package, starting on your first day of employment

• Health, Dental, Vision, Life Insurance and more.

• A 401k plan that includes a corporate match.

• Paid Time Off

  • 10 paid holidays per calendar year (8 fixed and 2 floating)

  • 6 paid wellness days

Career Development & Growth:

We provide ongoing training, coaching and development. We reward continuous improvement and encourage you to own your own development. Take advantage of some of the best training and tools in the world to learn more about multiple areas of Human Resources!

Alight provides a collaborative environment that embodies and holds the following stated values close to heart: Champion people, Grow with purpose, and Be Alight.

As a Claims Analyst, you can expect the following:

• When you start, you will receive extensive health care training to ensure you are equipped to consult members on billing related issues

• Your primary responsibility is to be an advocate for members by working on their behalf with carriers, providers, and plan related documentation to resolve post-service coverage questions and/or issues in an accurate and timely manner. Activities include, but are not limited to the following:

  • Assist in reviewing medical, dental, vision, and pharmacy related claims for accuracy to ensure members are receiving the proper benefit coverage according to plan stipulations

  • Coordinate with providers and carriers to solve billing discrepancies, coding errors, and denied claims; assist with claim resubmission, as necessary

  • Draft, submit, and exhaust appeals processes, as necessary

  • Partner directly with client to bring awareness to unique care/billing situations that may require special review

  • Coordinate with providers to determine payment plan and discount options

This work involves leveraging developed methodologies, navigating internal tools, and applications, as well as making external phone calls, and partnering with carriers and providers (via email and phone outreach) to resolve member needs. The scope of work is dedicated at the employee level and you will be responsible for working cases through resolution.

Required Qualifications

• Bachelor’s Degree, Associate’s Degree with 2 years billing/insurance experience, or 3 years’ experience in a healthcare billing/insurance related role

• Ability to work effectively in a remote team environment

• Strong problem solving, reasoning, and analytical skills

• Exceptional verbal and written communication skills – ability to articulate complex billing concepts for members that are not experts

• Strong ability and desire to learn continually in a changing environment

• Ability to efficiently organize work activities to meet deadlines

• Passion to provide the highest level of client satisfaction

• Ability to receive and immediately apply constructive feedback

• Ability to develop effective rapport with clients based on empathy and trust

Preferred Qualifications

• Expertise and current knowledge of Medicare, Health accounts (FSA, HRA, HSA), and claims adjudication process

We offer you a competitive total rewards package, continuing education & training, and tremendous potential with a growing worldwide organization.

Salary Pay Range

Minimum :

Maximum :

Pay Transparency Statement: Alight considers a variety of factors in determining whether to extend an offer of employment and in setting the appropriate compensation level, including, but not limited to, a candidate’s experience, education, certification/credentials, market data, internal equity, and geography. Alight makes these decisions on an individualized, non-discriminatory basis. Bonus and/or incentive eligibility are determined by role and level. Alight also offers a comprehensive benefits package; for specific details on our benefits package, please visit: Wellbeing and Benefits Selector Page - Alight

DISCLAIMER:

Nothing in this job description restricts management's right to assign or reassign duties and responsibilities of this job to other entities; including but not limited to subsidiaries, partners, or purchasers of Alight business units.