Health Pro - US Virtual

Alight Solutions•US-TX-Texas-Virtual, ND

9d•Remote

About The Position

As a Health Pro, you will be an advocate for members requiring guidance across the health benefits environment. Your primary responsibility is to help them navigate questions about their benefits, identify the highest quality and cost-effective providers, understand benefit claims, and act as 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. 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

2 years billing/insurance experience, or 3 years’ experience in a billing/insurance/benefits related role
Ability to work effectively in a remote team environment
Strong problem solving, critical thinking, and analytical skills – ability to comprehend a member’s needs and determine the steps required to complete their request
Exceptional written communication skills – can convey complex concepts in writing for members that are not benefits 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
Proficiency in MS Office suite

Nice To Haves

Previous healthcare setting experience
Previous benefits and/or HR experience

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