Claims Support Advocate (Temp)

Included Health; United States; On-site; USD 26,174 - 35,817; Full time

Job summary

Included Health is seeking a Claims Support Advocate to join our team in the United States. The role focuses on delivering high-quality member experiences by handling claim inquiries, coordinating with providers and insurers, and resolving claim issues within service level agreements.

Candidates should have 1 year of customer service experience and 3 years in revenue cycle or carrier roles, with strong communication and organizational skills. Medical billing/coding certification is a plus.

Qualifications

• 1 year experience in customer service
• 3 years revenue cycle or carrier experience
• Medical billing/coding certification is beneficial but not required
• College degree preferred or equivalent work experience

Responsibilities

• Provide effective and timely customer service for members, providers, insurers and clients regarding health care claims
• Organize health insurance paperwork and medical record documentation
• Negotiate with providers on plan member balances
• Appeal claim denials from the insurance company
• Explain benefits (EOBs) to members
• Assist with resolving claim errors or denials
• Collaborate with peers and management across functions
• Maintain professionalism and clear communication in a fast-paced environment

Skills

Customer service

Communication

Problem resolution

Time management

Note taking

Education

College degree preferred

CPC certification beneficial

Tools

Google apps

Slack

Job description

Job Summary:

As a Claims Support Advocate (CSA), you will be part of a vibrant team of high performing and highly engaged professionals that work to ensure a quality member experience within our service level agreements. The CSA serves as a liaison between plan members, providers and health insurance companies to resolve member claim inquiries. The CSA handles all communication, paperwork, and negotiations with a health insurance carrier or provider on the behalf of the plan member.

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

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

The hourly pay for this full time, contract position is $22.08per hour in the United States. This posted range reflects the portion of our internal pay band that is currently funded for new hires in this role across our standard labor markets (Zones A-C).