Claims Specialist
About The Position
Claims Resolution Champion At Health Advocate, we’re on a mission to simplify healthcare and empower our members to navigate their benefits confidently. If you’re ready to make a meaningful impact by resolving complex claims and advocating for those who need support, this is your chance to transform lives. As a Claims Specialist, you’ll go beyond solving billing issues—you’ll serve as an advocate, educator, and problem-solver for our members. By leveraging your expertise in claims, benefits, and coordination of care, you’ll ensure timely resolutions that ease stress and deliver value. In this role, you’ll join a team that values collaboration, precision, and compassion. This role is more than answering questions—it’s about being a trusted guide for our members.
Requirements
- Experienced Professional: You have at least 2 years of experience in healthcare, customer service, or claims.
- Problem-Solver: You excel at analyzing claims, identifying root causes, and proposing practical solutions.
- Empathetic Communicator: You possess strong listening skills and the ability to guide members with care and patience, even in complex or emotionally charged situations.
- Tech-Savvy: You’re proficient in MS Word and Excel and comfortable using internal databases to document and track cases.
Nice To Haves
- Knowledgeable and Resourceful: Familiarity with plan documents, ACA guidelines, Medicare, COBRA, and benefits such as dental, vision, and behavioral health is a plus.
Responsibilities
- Resolve Complex Claims Issues: Investigate billing discrepancies, identify errors, and coordinate resolutions among members, carriers, and providers for timely claim processing.
- Coordinate Benefits Across Carriers: Manage cases involving Medicaid, Medicare, motor vehicle claims, and other benefit programs, ensuring proper coordination.
- Educate and Empower Members: Help members understand their benefit plans, educate them on coverage details, and guide them through challenging claims scenarios.
- Ensure Accuracy: Adhere to internal policies, procedures, and federal regulations to process claims in a precise and timely manner.
- Collaborate and Escalate: Partner with team members and escalate unresolved issues to supervisors or carriers when necessary.
- Support Team Growth: Mentor new team members, share best practices, and contribute to continuous process improvements.
Benefits
- Competitive pay: Hourly pay rate starting at $20 per hour.
- Comprehensive Benefits: Enjoy competitive pay, robust medical, dental, and vision coverage, 401(k) with company match, PTO, and more.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
Number of Employees
1,001-5,000 employees
