Claims Specialist

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $20 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

📋 Claims Specialist

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Health Advocate

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

⚕️ Healthcare Insurance

Healthcare Insurance

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

• Resolve Complex Claims Issues: Investigate billing discrepancies, identify errors, and coordinate resolutions among members, carriers, and providers for timely claim processing. • Coordinate Benefits Across Carriers: Manage cases involving Medicaid, Medicare, motor vehicle claims, and other benefit programs, ensuring proper coordination. • Educate and Empower Members: Help members understand their benefit plans, educate them on coverage details, and guide them through challenging claims scenarios. • Ensure Accuracy: Adhere to internal policies, procedures, and federal regulations to process claims in a precise and timely manner. • Collaborate and Escalate: Partner with team members and escalate unresolved issues to supervisors or carriers when necessary. • Support Team Growth: Mentor new team members, share best practices, and contribute to continuous process improvements.

🎯 Requirements

• At least 2 years of experience in healthcare, customer service, or claims. • Problem-Solver: You excel at analyzing claims, identifying root causes, and proposing practical solutions. • Empathetic Communicator: You possess strong listening skills and the ability to guide members with care and patience, even in complex or emotionally charged situations. • Knowledgeable and Resourceful: Familiarity with plan documents, ACA guidelines, Medicare, COBRA, and benefits such as dental, vision, and behavioral health is a plus. • Tech-Savvy: You’re proficient in MS Word and Excel and comfortable using internal databases to document and track cases.

🏖️ Benefits

• Competitive pay: Hourly pay rate starting at $20 per hour. • Comprehensive Benefits: Enjoy competitive pay, robust medical, dental, and vision coverage, 401(k) with company match, PTO, and more. • Tools for Success: Access advanced systems, comprehensive training, and the support of a collaborative team. • A Culture of Care: Join a team that values empathy, innovation, and teamwork.