Claims Support Advocate

Responsibilities:

Your primary objective is to provide effective and timely customer service for members, providers, insurers and clients regarding health care claims
Ensure timely follow-up on requests for accounts to be reviewed
Organize health insurance paperwork and medical record documentation
Demonstrate knowledge of proprietary software and other required technology (Google apps, Slack, etc)
Communicate timely status updates to patients throughout the claims process
Negotiate with providers on plan member balances
Appeal claim denials from the insurance company
Contact providers and insurance companies to resolve claim concerns
Assist with understanding of explanation of benefits (EOBs)
Assisting members with resolving claim errors or denials. Ideally to recoup or lower their medical expenses
Collaborate with peers and management across functions
Understand the evolving business requirements and adapt the operational processes to meet those requirements
Speak clearly, confidently and maintain professionalism as well as friendly member interactions while demonstrating persuasion in overcoming objections
Ability to handle a fast-paced, dynamic environment with competing priorities
Model a culture reflective of our core company values
Gain and retain a thorough understanding of the team and company policies, processes, software, etc
Including other duties and responsibilities as assigned by leadership

Required Qualifications:

• 1 year experience in customer service roles
• 3 years of revenue cycle or carrier experience
• Passion for providing support
• Prior work experience in a claims support and health insurance role
• Ability to take meticulous notes and document actions taken
• Highly effective communication, problem resolution and organizational skills
• Demonstrated ability to meet goals in a rapidly changing environment
• Excellent data and overall analytical skills
• Excellent written and verbal communication skills
• Proven record of excellent time management and prioritization skills
• Ability to troubleshoot basic technical issues
• Proven track record of driving measurable efficiency results.

Preferred Qualifications:

• College degree preferred (additional experience in lieu of college degree will be considered)
• Medical billing/coding certification (CPC) is beneficial, but not required

Physical/Cognitive Requirements:

Prompt and regular attendance at assigned work location.
Ability to remain seated in a stationary position for prolonged periods.
Requires eye-hand coordination and manual dexterity sufficient to operate keyboard, computer and other office-related equipment.
No heavy lifting is expected, though occasional exertion of about 20 lbs. of force (e.g., lifting a computer / laptop) may be required.
Ability to interact with leadership, employees, and members in an appropriate manner.

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