Temporary Benefits Claims Advocate

Calvert County Government

1d

About The Position

Performs specialized administrative and customer service work assisting employees with health insurance claims and coverage issues. The work involves coordinating with employees, medical providers, and insurance carriers to resolve claims discrepancies, ensure proper benefits application, and support accurate claims processing. This position is temporary and project-based, created to address increased workload during a system transition. Work is performed under general supervision. Essential Job Functions Provides direct assistance to employees by receiving, reviewing, and documenting health insurance claims issues and concerns. Conducts research and analysis of claims discrepancies, including denials, billing errors, and eligibility issues. Coordinates and participates in real-time communications between employees, medical providers, and insurance carrier representatives to resolve claims issues. Explains benefit plan provisions, including coverage rules and plan design, to ensure accurate billing and claims processing. Monitors claims through the resolution process, ensuring corrections are completed and claims are properly reprocessed. Maintains detailed records of case activity, including actions taken, status updates, and final outcomes. Prioritizes cases based on urgency and impact, including active treatment situations and high-cost claims. Follows up with stakeholders to ensure timely resolution. Identifies trends and recurring issues in claims processing and communicates findings to Human Resources staff for further review or escalation. Coordinates with internal staff and external representatives to address unresolved or complex issues. Provides responsive, high-touch customer service to employees by explaining processes, next steps, and expected timelines, and by reducing the burden on employees navigating benefits issues. Performs related work as required.

Requirements

• High school diploma or GED equivalent.
• Two (2) years of experience in employee benefits administration, health insurance claims, customer service, medical billing, or a related field.

Nice To Haves

• Experience working with health insurance carriers, particularly CareFirst or Blue Cross Blue Shield.
• Familiarity with self-insured health plans.
• Experience handling complex or high-volume casework.

Responsibilities

• Provides direct assistance to employees by receiving, reviewing, and documenting health insurance claims issues and concerns.
• Conducts research and analysis of claims discrepancies, including denials, billing errors, and eligibility issues.
• Coordinates and participates in real-time communications between employees, medical providers, and insurance carrier representatives to resolve claims issues.
• Explains benefit plan provisions, including coverage rules and plan design, to ensure accurate billing and claims processing.
• Monitors claims through the resolution process, ensuring corrections are completed and claims are properly reprocessed.
• Maintains detailed records of case activity, including actions taken, status updates, and final outcomes.
• Prioritizes cases based on urgency and impact, including active treatment situations and high-cost claims.
• Follows up with stakeholders to ensure timely resolution.
• Identifies trends and recurring issues in claims processing and communicates findings to Human Resources staff for further review or escalation.
• Coordinates with internal staff and external representatives to address unresolved or complex issues.
• Provides responsive, high-touch customer service to employees by explaining processes, next steps, and expected timelines, and by reducing the burden on employees navigating benefits issues.
• Performs related work as required.

What This Job Offers

• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 1-10 employees