Claims Support Advocate (Temp)

As a Claims Support Advocate (CSA), you will be part of a vibrant team of high performing and highly engaged professionals that work to ensure a quality member experience within our service level agreements. The CSA serves as a liaison between plan members, providers and health insurance companies to resolve member claim inquiries. The CSA handles all communication, paperwork, and negotiations with a health insurance carrier or provider on the behalf of the plan member.

Responsibilities

Provide effective and timely customer service for members, providers, insurers and clients regarding health care claims; Ensure timely follow-up on requests for accounts to be reviewed; Organize health insurance paperwork and medical record documentation; Demonstrate knowledge of proprietary software and other required technology (Google apps, Slack, etc); Communicate timely status updates to patients throughout the claims process; Negotiate with providers on plan member balances; Appeal claim denials from the insurance company; Contact providers and insurance companies to resolve claim concerns; Assist with understanding of explanation of benefits (EOBs); Assisting members with resolving claim errors or denials. Ideally to recoup or lower their medical expenses; Collaborate with peers and management across functions; Understand the evolving business requirements and adapt the operational processes to meet those requirements; Speak clearly, confidently and maintain professionalism as well as friendly member interactions while demonstrating persuasion in overcoming objections; Ability to handle a fast-paced, dynamic environment with competing priorities; Model a culture reflective of our core company values; Gain and retain a thorough understanding of the team and company policies, processes, software, etc; Including other duties and responsibilities as assigned by leadership

Requirements

1 year experience in customer service roles; 3 years of revenue cycle or carrier experience; Passion for providing support; Prior work experience in a claims support and health insurance role; Ability to take meticulous notes and document actions taken; Highly effective communication, problem resolution and organizational skills; Demonstrated ability to meet goals in a rapidly changing environment; Excellent data and overall analytical skills; Excellent written and verbal communication skills; Proven record of excellent time management and prioritization skills; Ability to troubleshoot basic technical issues; Proven track record of driving measurable efficiency results

Nice to have

Medical billing/coding certification (CPC) is beneficial, but not required; College degree preferred (additional experience in lieu of college degree will be considered)