Claims Associate

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

📋 Claims Specialist

🚫👨‍🎓 No degree required

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Health Advocate

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

💼 Consulting

📣 Marketing

Healthcare • Consulting • Marketing

Health Advocate is a company dedicated to making healthcare easier for organizations and their members. Utilizing a combination of personal support, data, and technology, they offer a whole-person approach to improve health outcomes, reduce absenteeism and presenteeism, and lower costs. Their services include health advocacy and navigation, clinical care management, emotional health support, and personalized well-being programs. Health Advocate caters to over 12,500 organizations, offering 24/7 support in over 250 languages and ensuring HIPAA compliance and NCQA certification.

📋 Description

• Handle assigned claims cases in a timely manner • Research and resolve benefit claims issues, billing discrepancies, coding errors, and insurance claims processing issues • Educate members about benefit plan coverage and applicable policies • Work with plan documents, carriers, healthcare providers, members, and supervisors to resolve issues • Research conflicting plan information and escalate for clarification when needed • Research billing errors and assist with claims resubmission • Help members establish payment arrangements and contact healthcare providers about payment options • Use plan documents, benefit summaries, enrollment materials, and coverage information to resolve billing issues • Maintain current knowledge of FSA, HRA, HSA, and SPD information • Process claims in accordance with policies, procedures, quality standards, and federal laws and regulations • Assist with routine program quality issues and claims research • Contact healthcare providers to obtain documentation such as bills and medical records • Follow claims research through resolution • Document claims issues and maintain department files and databases • Prioritize work to provide timely, quality service • Monitor issue trends and escalate them to supervisors • Maintain professional relationships with internal and external customers and team members • Cooperate with team members to meet goals and complete tasks • Provide exceptional customer service and escalate situations outside the employee's control

🎯 Requirements

• High School Degree or GED required • Associate degree in business administration, liberal arts, public health, healthcare management, or a related field preferred • Minimum of one year of customer service, healthcare, or claims experience required • Basic knowledge of MS Word and Excel required • Must score acceptably on job-related testing • Ability to pass a standardized interview • May need to be bilingual in English, Spanish, etc., depending on the program • Knowledge of the Affordable Care Act (ACA), COBRA, Medicare, benefit plan options, group benefits, medical benefits, pharmacy benefits, vision benefits, FSA/HSA, HRA, disability, long-term care, individual health plans, and short-term plans preferred • Strong concentration and attention to detail • Critical thinking and problem-solving skills • Effective verbal and written communication skills • Ability to work in a distraction-free home office environment • Ability to use computers, telephones, printers, and general computer software continuously throughout the workday • Ability to perform prolonged sitting, typing, mouse navigation, reading on screen, fingering, grasping, pulling hand-over-hand, and repetitive motions

🏖️ Benefits

• Training provided to perform the job well • Room for career growth • Supportive and friendly supervisors and staff • Fully remote work • Home office environment