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Claims Specialist

Remote: 
Full Remote
Contract: 
Salary: 
41 - 48K yearly
Work from: 

Offer summary

Qualifications:

Bachelor's Degree or applicable work experience, Claims or call center experience preferred, Basic computer skills, Familiarity with various types of health insurance.

Key responsabilities:

  • Negotiate consumer/member medical claims
  • Manage multiple claims cases and track settlements
Health Advocate logo
Health Advocate Health, Sport, Wellness & Fitness Large https://www.healthadvocate.com/
1001 - 5000 Employees
See all jobs

Job description

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®)

Position Overview
At Health Advocate, we are committed to providing our customers with expertise and services that improve the health, well-being and productivity of their employees. We are looking for the right person to: work with medical providers to negotiate balances outstanding on members claims.
The appropriate candidate would be responsible for managing multiple claims cases, interfacing with internal staff and external providers to understand and negotiate claims balances. The appropriate candidate will follow up to ensure all aspects of the negotiation are documented and processed for member satisfaction.
Essential Job Functions
• Handles Member calls & cases for claims fee negotiation
• Negotiates Consumer/Member Medical Claims with Healthcare Providers
• Send and Acknowledge receipt of Contracts from Consumers/Members and Providers
• Tracks all Settlements
• Reports Settlement results within the system and Statistics to Management
• Works with other Health Advocate units, including training when requested
• Works with product development VP to refine process and improve the Consumer/Member Settlement product
• Supports Sales & Marketing as SME, including participation in meetings with Current and Prospective Customers
• Provide benefit and claims consultation and support when appropriate to all internal departments.

Minimium Requirements
• Claims or Call center experience preferred
• Bachelor's Degree or applicable work experience.
• Effective communication skills to interact with members, physicians, and insurance carrier representatives, with an emphasis on ability to communicate both verbally and in writing.
• Assertive, self-confident, and resilient.
• Basic computer skills.
• Ability to search and identify resources through the internet.
• Demonstrated ability to communicate concepts, strategies and plans in terminology understood by business professionals.
• Ability to interpret Explanation of Benefits (EOBs).
• Familiarity with various types of health insurance coverage, coordination of benefits, and UCR fees.

Equal Opportunity Employer. All qualified applicants will receive consideration for employment and will not be discriminated against based on race. color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age, pregnancy, genetic information or any other consideration prohibited by law or contract.

Job Type: Full-time

Pay Rate

$21.50- $25/ hr

Company's website:

  • https://www.healthadvocate.com/site/

Company's Facebook page:

  • https://www.facebook.com/healthadvocateinc/

About US:

Health Advocate is the nation’s leading provider of health advocacy, navigation, well-being and integrated benefits programs. For nearly 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.

Silver winner - Best in Biz Award 2020
Most Customer-Friendly Company of the Year

Silver winner - Stevie® Award 2020
Healthcare Customer Service Department of the Year

Bronze winner - Stevie® Award 2020
Most Valuable Response by a Customer Service Team

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)

Required profile

Experience

Industry :
Health, Sport, Wellness & Fitness
Spoken language(s):
English
Check out the description to know which languages are mandatory.

Other Skills

  • Computer Literacy
  • Communication
  • Self-Confidence
  • Assertiveness
  • Resilience

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