Healthcare Benefit Advocate - In Office

Ccmsi • Metairie, LA

13d • Onsite

About The Position

CCMSI is seeking a Healthcare Benefits Advocate to serve as a trusted resource for members, healthcare providers, employers, and plan administrators regarding health insurance benefits, medical claims, eligibility, and coverage questions. This role requires a strong understanding of health insurance, medical claims, benefits administration, medical billing, or healthcare reimbursement to interpret benefit plans, investigate claim issues, explain coverage provisions, and advocate for appropriate claim resolution. The ideal candidate enjoys helping people, is comfortable speaking with members and providers throughout the day, and can successfully navigate complex healthcare benefit questions while delivering exceptional service.

Requirements

• High School Diploma or equivalent
• Medical terminology knowledge required
• Minimum two years of experience in one or more of the following: Health insurance, Benefits administration, Health claims processing, Medical billing, Customer service within a healthcare environment, Healthcare reimbursement, Third-Party Administration (TPA)
• Strong verbal and written communication skills
• Strong organizational and time-management skills
• Ability to research and resolve benefit and claim issues
• Ability to manage multiple priorities and deadlines
• Strong attention to detail and accuracy
• Ability to maintain confidentiality and professionalism
• Proficiency with Microsoft Office applications, including: Outlook, Word, Excel
• Reliable attendance during scheduled business hours
• Ability to speak to groups of 20-100 attendees for presentations

Nice To Haves

• Associate degree
• Experience interpreting health plan documents and benefit structures
• Experience with medical claims billing, payment, and posting
• Experience handling benefit appeals
• Knowledge of medical coding
• Experience supporting governmental or public entity benefit programs
• Prior benefits customer service experience

Responsibilities

• Serve as a primary point of contact for members, healthcare providers, employers, and plan administrators regarding health benefit plans and medical claims.
• Research and resolve claim issues, payment discrepancies, eligibility concerns, and coverage questions.
• Interpret benefit plan documents, schedules of benefits, exclusions, limitations, coordination of benefits, and subrogation provisions.
• Explain claim determinations, payment calculations, deductibles, copays, coinsurance, and out-of-pocket responsibilities.
• Investigate denied claims and assist with claim reconsiderations and appeals.
• Process medical, dental, and prescription benefit transactions in accordance with client plan provisions.
• Collaborate with providers, clients, medical reviewers, and internal teams to obtain information necessary for claim resolution.
• Educate members regarding healthcare benefits and available coverage options.
• Maintain accurate documentation and correspondence within company systems.
• Support claim audits, special projects, and benefit administration activities as assigned.
• Assist with onboarding and training of newer team members when requested.

Benefits

• 4 weeks (Paid time off that accrues throughout the year in accordance with company policy)
• 10 paid holidays in your first year
• Medical Insurance
• Dental Insurance
• Vision Insurance
• Life Insurance
• Disability Insurance
• 401(k)
• Employee Stock Ownership Plan (ESOP)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED