Why is Health Advocate a great place to work? For starters, Health Advocate employees enjoy helping people every single day. Employees are given the training they need to do their jobs well, and they work with supervisors and staff who are supportive and friendly. Employees have room to grow, and many of Health Advocate’s supervisors are promoted from within the company.
Summary of Role
Our Claims Associates are responsible for handling assigned cases in a timely manner to identify opportunities to resolve the issue by working with plan documents, carriers, providers, and members; research billing issues to determine the possible cause of the error and assist with claims resubmission when needed to correct the issues; assist members with setting up payment arrangements which may include reaching out to healthcare providers to determine payment options and discussing options with supervisor; exercise exceptional customer services skills in an effort to optimize each contact with the member; play an important role in assisting members in understanding their healthcare claims status and resolve adjudication issues with health plans and third party administrators. It is an integral role to help our members get the most of their healthcare benefits.
If you are someone who thrives in making a difference by helping others, have customer service experience, and are committed to making a contribution while growing your career in the benefits administration industry this is the job for you. We have training classes starting soon to help you build the successful career that you want – apply today!
Your Success (training and equipment information)
As a work from home associate, you’ll deliver a positive experience that solves members’ needs/challenges, while working to resolve issues.
Health Advocate offers all work equipment and a comprehensive new-employee training program to help you develop the knowledge and skills that will set you up for success in your role and in supporting our members.
Invested in you (benefits)
At Health Advocate, you’ll have the ability to pursue your ambitions and grow your career. We’ve got you covered with a total rewards package that includes Robust Medical coverage, as well as Dental & Vision benefits, tuition assistance, 401(k) savings plan with company match, paid time off (PTO), paid holidays, Employee Assistance Programs and Wellness Programs.
Pay Rate
Hourly rate starting at $19.00.
Hours/Shift
This position is full-time (40 hours/week) Monday – Friday. It may be necessary, given the business need, to work occasional overtime.
Job Summary
Handle assigned cases in a timely manner to identify opportunities to resolve the issue by working with plan documents, carriers, providers, and members
Research plan information and identify where there may be conflicting information which may include escalating to supervisor or other levels of management for clarification and assistance
Research billing issues to determine the possible cause of the error and assist with claims resubmission when needed to correct the issue
Assist members with setting up payment arrangements which may include reaching out to healthcare providers to determine payment options and discussing options with supervisor
Utilize a variety of resources to research and resolve billing issues (e.g., plan documents, summary plan documents, benefits summaries, open enrollment material interpretation of benefits, understanding of medical, dental vision and behavioral health coverage, etc.)
Remain current on knowledge of Flexible Spending Accounts (FSA), Health Reimbursement Accounts (HRA), Health Spending Accounts (HSA), and benefits Summary Plan Descriptions (SPD) to resolve billing issues
Exercise exceptional customer service skills in an effort to optimize each contact with the member
Ensure that claims are processed in strict adherence to established policies, procedures, quality standards as well as applicable federal laws and regulations
Know and support approved departmental and corporate policies and procedures relating to claims issues
Team Interfaces/Customer Service – Establish and maintain a professional relationship with internal/external customers, team members and department contacts
Cooperate with team members to meet goals or complete tasks
Provide quality customer service that exceeds customer expectations and improves level of service being provided
Treat all internal/external customers, team members and department contacts with dignity/respect
Escalate to supervisor any situation outside the employee’s control that could adversely impact the services being provided
Related Duties as Assigned
The job description documents the general nature and level of work but is not intended to be a comprehensive list of all activities, duties, and responsibilities required of job incumbents
Consequently, job incumbents may be asked to perform other duties as required
Also note, that reasonable accommodations may be made to enable individuals with disabilities to perform the functions outlined above
Please contact your local Employee Relations representative to request a review of any such accommodations
Minimum Requirements
Education
High School Degree or GED required
Associate degree from an accredited college or university with major course work in business administration, liberal arts, public health, healthcare management, or a related field is preferred.
Experience
Minimum of one year customer service, healthcare, or claims experience required.
Basic Knowledge of MS Word and Excel required
Knowledge of the following is preferred:
Group Benefits (Fully Insured vs. Self-Insured)
Affordable Care Act (ACA) (Marketplace Navigation and Exchange plan review and comparison)