Claims Specialist

Job not on LinkedIn

🕒 July 15

🇺🇸 United States – Remote

💵 $18 / hour

⏰ 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

• Investigate billing discrepancies and resolve complex claims issues • Identify errors and coordinate resolutions among members, carriers, and providers • Coordinate benefits across Medicaid, Medicare, motor vehicle claims, and other benefit programs • Educate members about benefit plans and coverage details • Guide members through challenging claims scenarios • Process claims accurately and promptly according to internal policies, procedures, and federal regulations • Collaborate with team members and escalate unresolved issues to supervisors or carriers • Mentor new team members and share best practices • Contribute to continuous process improvements • Document and track cases using internal databases • Communicate with members, team members, clients, carriers, providers, and external parties by phone and in writing

🎯 Requirements

• At least 2 years of experience in healthcare, customer service, or claims • Strong ability to analyze claims, identify root causes, and propose practical solutions • Strong listening skills and ability to guide members with care and patience • Familiarity with plan documents, ACA guidelines, Medicare, COBRA, dental, vision, and behavioral health benefits is a plus • Proficiency in MS Word and Excel • Comfortable using internal databases to document and track cases • Private, HIPAA-compliant workspace where confidential member information cannot be viewed or overheard • Sufficient desk space for a dual-monitor workstation and related equipment • Reliable high-speed internet with a minimum download speed of 200 Mbps • Professional, distraction-free home work environment during scheduled hours • Ability to perform prolonged sitting and extensive computer, phone, typing, mouse, fingering, grasping, pulling hand-over-hand, and repetitive-motion tasks • Strong concentration and attention to detail • Critical-thinking and problem-solving skills • Effective verbal and written communication skills

🏖️ Benefits

• Training and comprehensive onboarding support • Room for growth and internal promotion opportunities • Competitive pay starting at $18.00 per hour • Medical coverage • Dental coverage • Vision coverage • 401(k) with company match • PTO • Advanced systems and comprehensive training • Collaborative team support • Computer equipment, monitors, and other necessary technology provided by Health Advocate