Claims Support Advocate

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