Job Summary:

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:

Your primary objective is to 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

Qualifications:

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

The hourly pay for this full time, contract position is $22.08 per hour in the United States. This posted range reflects the portion of our internal pay band that is currently funded for new hires in this role across our standard labor markets (Zones A–C).

For context, these markets include Zone A (e.g., Phoenix AZ, San Antonio TX, Columbus OH, Charlotte NC), Zone B (e.g., Chicago IL, Denver CO, San Diego CA, Houston TX), and Zone C (e.g., Los Angeles CA, Seattle WA, Washington, D.C., Boston MA). At this time, we are not budgeting for hires in higher-cost Zone D markets (e.g., San Francisco Bay Area CA, New York City NY, San Jose CA) for this role. Within this range, individual pay is determined by work location, skills, experience, and internal equity. We use structured pay bands and geographic zones based on cost of labor to keep pay fair and consistent.

Job Summary:

Responsibilities:

Your primary objective is to 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

Qualifications:

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

Claims Support Advocate (Temp)

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Claims Support Advocate (Temp)

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