Health Pro Consultant - US Virtual

Alight • Wyoming, NV

1d • Remote

About The Position

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 Offer You
A competitive total rewards package, continuing education & training, and tremendous potential with a growing worldwide organization:
A full Benefits Package, starting on your first day of employment
Health, Dental, Vision, Life Insurance and more.
A 401k plan that includes a corporate match.
Paid Time Off
10 paid holidays per calendar year (8 fixed and 2 floating)
6 paid wellness days
Career Development & Growth:
We provide ongoing training, coaching and development specific to the Health Pro role and reward continuous improvement while encouraging you to own your own development.
Alight provides a collaborative environment that embodies and holds the following stated values close to heart: Champion People, Grow with Purpose, and Be Alight.
As a Health Pro, you can expect the following:
When you start, you will receive extensive health care and case management training to ensure you are equipped to support members on complicated healthcare matters
Your primary responsibility is to be an advocate for members requiring guidance across the health benefits environment by helping them navigate questions about their benefits, identify the highest quality and cost-effective providers, understand benefit claims, and be an advocate for the employee across the health ecosystem. You will gather a full understanding of the members’ needs and own the resolution of the customer’s request. Activities include, but are not limited to the following:
Gathering information about the reason the customer is seeking support or care
Educating members on benefit programs provided by clients
Translating complex benefit details (e.g., deductibles, coverage limits, prior authorizations) into clear, actionable guidance members can understand and use
Delivering provider recommendations, referral guidance, and connections to clinical or employer‑sponsored programs to support informed care decisions
Completing cost estimates and communicating out‑of-pocket responsibility, claim results, denials, appeals, and escalation outcomes with accurate expectations and timelines
Explaining prescription formulary options, prescription alternatives, prior authorization outcomes, and available cost‑saving opportunities
Proactively identifying unmet clinical needs and owning the connection to appropriate clinical support and care resources
Connecting members to company sponsored health and benefits programs for specialized care
Providing proactive, timely updates via phone and digital channels and ensuring members feel supported through full case resolution
Navigating medical bill review results, including identified errors and savings achieved, and translating findings into clear, actionable guidance for members
Drafting carrier and client appeals for healthcare services
Coordinating records transfers and authorization requests that require pre-service approval
This work involves leveraging developed methodologies, navigating internal tools and applications, as well as making external phone calls, partnering with carriers and providers (via email and phone outreach) to resolve member needs. The scope of work is dedicated at the employee level and you will be responsible for working employee cases through resolution.
You will interact with members through incoming calls, emails, and messaging system interactions. You will be responsible for utilizing exceptional communication, empathy, and problem solving skills to understand and solve complex customer needs, resulting in a better experience for the employee’s entire healthcare journey.

Requirements

• Minimum of 2 years of experience in a medical assistant/medical support role, or 3 years of experience working in a customer-facing role within the healthcare industry
• Ability to work effectively in a remote team environment
• Strong listening, reasoning, and analytical skills – ability to listen to members’ needs and dig deeper to understand the root cause of their concern with empathy.
• Exceptional verbal and written communication skills – can convey complex concepts, both verbally and in writing, for members that are not benefits experts
• Strong ability and desire to learn continually in a changing environment
• Exceptional critical thinking and problem-solving skills
• 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
• Proficiency in MS Office suite

Responsibilities

• Gathering information about the reason the customer is seeking support or care
• Educating members on benefit programs provided by clients
• Translating complex benefit details (e.g., deductibles, coverage limits, prior authorizations) into clear, actionable guidance members can understand and use
• Delivering provider recommendations, referral guidance, and connections to clinical or employer‑sponsored programs to support informed care decisions
• Completing cost estimates and communicating out‑of-pocket responsibility, claim results, denials, appeals, and escalation outcomes with accurate expectations and timelines
• Explaining prescription formulary options, prescription alternatives, prior authorization outcomes, and available cost‑saving opportunities
• Proactively identifying unmet clinical needs and owning the connection to appropriate clinical support and care resources
• Connecting members to company sponsored health and benefits programs for specialized care
• Providing proactive, timely updates via phone and digital channels and ensuring members feel supported through full case resolution
• Navigating medical bill review results, including identified errors and savings achieved, and translating findings into clear, actionable guidance for members
• Drafting carrier and client appeals for healthcare services
• Coordinating records transfers and authorization requests that require pre-service approval

Benefits

• A full Benefits Package, starting on your first day of employment
• Health, Dental, Vision, Life Insurance and more.
• A 401k plan that includes a corporate match.
• Paid Time Off
• 10 paid holidays per calendar year (8 fixed and 2 floating)
• 6 paid wellness days
• Career Development & Growth:
• We provide ongoing training, coaching and development specific to the Health Pro role and reward continuous improvement while encouraging you to own your own development.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed