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. Join our award winning team!
2024:
Excellence in Customer Service Awards: Organization of the Year (Small)
Stevie® Awards for Sales & Customer Service: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries, Bronze Winner
As part of Teleperformance in the US, we were also named #95 in the 2024 ‘Fortune 100 Best Companies to Work For®’ in the USA by Great Places to Work (GPTW®)
Basic Function
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 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; exercise exceptional customer service skills in an effort to optimize each contact with the member
Major Accountabilities
Claims Associate Functions: Provide first-line assistance for member’s questions relating to post-service coverage of medical treatment or services which includes researching and resolving benefit claims issues, billing discrepancies, coding errors, insurance claims processing issues, and educating members on the components of their benefit plan coverage which ensuring adherence to corporate and department policies and procedures
- 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
Claims Research Assistance - Assist in resolving routine program quality issues by identifying issue(s) and researching in a timely manner
- Research and evaluate billing issues to determine the possible cause of the error ensuring to assist the client with claims resubmission correct the issue
- As needed, contact healthcare providers to gather documentation (e.g., bills, medical records, etc.) ensuring to notify management if the request cannot be obtained
- Follow claims research through until resolution
- Document all claims issues thoroughly maintaining department files and appropriate databases
- Continuously evaluate the status of all work efforts, ensuring all tasks are prioritized to assist in providing timely and quality services
- Assist in monitoring issue trends, escalating such trends to supervisor to determine appropriate actions necessary to eliminate future occurrences and improve service levels
- 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
Mental and Physical Requirements
- This position will be exposed mainly to an indoor office environment and will be expected to work near or around computers, telephones, and printers
- The nature of the work in this position is sedentary and the incumbent will be sitting most of the time.
- Essential physical functions of the job include fingering, grasping, pulling hand over hand, and repetitive motions to utilize general computer software/hardware continuously throughout the work day
- Essential mental functions of this position include concentrating on tasks, reading information, and verbal/written communication to others continuously throughout the work day
- 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 QUALIFICATIONS
- Applicant for this job will be expected to meet the following minimum qualifications.
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.
Other
- Basic Knowledge of MS Word and Excel required
- Must score acceptably on job related testing
- Ability to pass standardized interview
- Based on program may need to be bilingual in English, Spanish, etc.
- Knowledge of the following is preferred:
- Affordable Care Act (ACA) (Marketplace Navigation and Exchange plan review and comparison)
- Consolidated Omnibus Budget Reconciliation Act (COBRA)
- Medicare (Part A, Part B, Part D, Advantage and MediGap Plans)
- Compare and contrast benefit plan options (Open Enrollment, New Hire, Qualifying Life Event (QLE), and other Special Enrollment Periods)
- Group Benefits (Fully Insured vs. Self-Insured)
- Medical Benefits (CDHP/HDHP, PPO, POS, and HMO Plans)
- Pharmacy Benefits
- Dental Benefits
- Vision Benefits
- Long Term and Short Term Disability and Long Term Care
- Individual Health Plans
- Short Term Plans
Pay Rate
$19.50- $23/ hr
Company Overview
Health Advocate is the nation’s leading provider of health advocacy, navigation, well-being and integrated benefits programs. For 20 years, Health Advocate has provided expert support to help our members navigate the complexities of healthcare and achieve the best possible health and well-being. Our solutions leverage a unique combination of best-in-class, personalized support with powerful predictive data analytics and a proprietary technology platform to address nearly every clinical, administrative, wellness or behavioral health need. Whether facing common issues or an unprecedented challenge like COVID-19, our team of highly trained, compassionate experts work together to go above and beyond expectations, making healthcare easier for our members and ensuring they get the care they need.
Learn more
Health Advocate https://www.healthadvocate.com/site/
Facebook https://www.facebook.com/healthadvocateinc/
Video https://vimeo.com/386733264/eb447da080
Awards:
2023:
- National Customer Service Association All-Stars Award: Service Organization of the Year.
- Stevie® Awards for Sales & Customer Service: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries, Bronze Winner
2022:
- Stevie® Awards for Sales & Customer Service: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries, Bronze Winner
- Excellence in Customer Service Awards: Organization of the Year (Small)
- Best in Biz Awards: Most Customer-Friendly Company of the Year – Medium and large category (Silver)
2021:
- Stevie® Awards for Sales & Customer Service: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries, Silver Winner
- Stevie® Awards for Sales & Customer Service: Most Valuable Response by a Customer Service Team (COVID-19). Bronze Winner
- Best in Biz Awards: Most Customer-Friendly Company of the Year – Medium and large category (Silver)
2020:
- National Customer Service Association All-Stars Award: Organizations of 100 or Greater, Runner-Up
- Communicator Award of Distinction: October 2019 Broker News
- MarCom Awards: Gold, COVID Staycation Ideas brochure
- MarCom Awards: Platinum, 2021 Well-being Calendar
- Best in Biz Awards: Most Customer-Friendly Company of the Year - Medium category (Silver)
Health Advocate is an Equal Opportunity Employer that does not discriminate on the basis of race, color, sex, age, religion, national origin, citizenship status, military service and veteran status, physical or mental disability, or any other factor not related to job requirements. We respect and value diversity, and are committed to the principles of Equal Employment Opportunity.
VEVRAA Federal Contractor requesting appropriate employment service delivery systems, such as state workforce agencies and local employment delivery systems, to provide priority referrals of protected veterans.
PAY TRANSPARENCY NONDISCRIMINATION PROVISION
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-I.35(c)
