Claims Analyst

Alight Solutions

1d•Remote

About The Position

Our Story At Alight, we believe a company’s success starts with its people. At our core, we Champion People, help our colleagues Grow with Purpose and true to our name we encourage colleagues to “Be Alight.” We are passionate about connecting purpose with impact. Alight empowers clients to build a healthier and more financially secure workforce by unifying the benefits ecosystem across health, wealth, wellbeing, navigation, and absence management. Our Benefits With a comprehensive total rewards package, Alight offers programs and plans that support your mind, body, wallet, and life. Benefits include health, dental and vision coverages starting Day One. Additionally, Alight colleagues enjoy wellbeing programs, retirement plans with contribution matching, generous time off, parental leave, continuing education, and career growth opportunities – all within a thriving global organization. Flexible Working So that you can be your best at work and home, we consider flexible working arrangements wherever possible. Alight has been a leader in the flexible workspace and “Top 100 Company for Remote Jobs” 6 years in a row. Great Place to Work Thanks to the work of every colleague, Alight has received multiple awards of recognition including “Great Place to Work” for the past 7 years and Fortune’s “Best Companies to Work For.” To learn more about our company culture and awards Click Here. If you, Champion People, seek to Grow with Purpose, and embody the meaning of Be Alight – We invite you to join our team! Learn more at careers.alight.com. We are now hiring ambitious, motivated Claim Analysts to work in our team focused, premier healthcare navigation business. In this role, you will be leveraging acquired knowledge to deliver high quality customer interactions that are consultative and lead to better healthcare outcomes. Through this role, you will have the opportunity to positively impact the lives of employee customers and their families, while driving increased benefit satisfaction and reducing healthcare spend for their employers.

Requirements

Bachelor’s Degree, Associate’s Degree with 2 years billing/insurance experience, or 3 years’ experience in a healthcare billing/insurance related role
Ability to work effectively in a remote team environment
Strong problem solving, reasoning, and analytical skills
Exceptional verbal and written communication skills – ability to articulate complex billing concepts for members that are not experts
Strong ability and desire to learn continually in a changing environment
Ability to efficiently organize work activities to meet deadlines
Passion to provide the highest level of client satisfaction
Ability to receive and immediately apply constructive feedback
Ability to develop effective rapport with clients based on empathy and trust

Nice To Haves

Expertise and current knowledge of Medicare, Health accounts (FSA, HRA, HSA), and claims adjudication process

Responsibilities

Be an advocate for members by working on their behalf with carriers, providers, and plan related documentation to resolve post-service coverage questions and/or issues in an accurate and timely manner.
Assist in reviewing medical, dental, vision, and pharmacy related claims for accuracy to ensure members are receiving the proper benefit coverage according to plan stipulations.
Coordinate with providers and carriers to solve billing discrepancies, coding errors, and denied claims; assist with claim resubmission, as necessary.
Draft, submit, and exhaust appeals processes, as necessary.
Partner directly with client to bring awareness to unique care/billing situations that may require special review.
Coordinate with providers to determine payment plan and discount options.
Leverage developed methodologies, navigating internal tools, and applications, as well as making external phone calls, and partnering with carriers and providers (via email and phone outreach) to resolve member needs.
Work cases through resolution.