Client Advocate

OneDigital - Remote

OneDigital is proud of the tight-knit community we’ve built since the day we were founded. We’re picky about the people who work for us, because as much as we are a business, we’re also a family. Even through our rapid growth, we’ve managed to preserve our unique culture. We have a simple philosophy that if you take care of your employees, they will take care of customers and the bottom line takes care of itself.

With a distinctive culture, the best-in-class products and outstanding service, OneDigital has been recognized time and time again for our accomplishments within our industry as well as what we offer within our organization. Are you ready to join an already winning team and help us continue to grow for years to come?

Our Newest Opportunity:
The Client Advocate – Claims Specialist is licensed and considered a Subject Matter Expert within the Client Advocate Center in regards to claims and claims issues. This person focuses on member claims that are paid out of alignment from plan benefits. This can occur due to provider billing code error, emergency services sought with out-of-network providers (without input from the member or dependent due to the emergent nature of the issue), or carrier error. This Client Advocate works cross-regional service requests and follow-up tasks, and is available to accept inbound calls from the telephone queue regarding claims as needed. This position is hourly and non-exempt for overtime (meaning: is eligible for overtime).

Job Responsibilities:
Diagnose and resolve complex/escalated customer requests and issues related to claims, which can be received via phone, fax, email, and chat.
Calls clients for additional information as needed, uses HIPAA law & applicable OneDigital policy as well as Effortless Client Experience training with every interaction.
Work cross-functionally with other internal departments and external agencies and carriers to resolve complex customer issues.
Identify opportunities for process improvement and participate in the development of solutions to improve key metrics.
Provides back up support for the team regardless of geography as necessary to ensure smooth department operations.
Ensure the protection and security of a consumer’s personal, confidential and identifiable information in a professional and responsible manner, according to the standards and requirements of the Health Insurance Portability and Accountability Act (HIPAA).
Other duties as requested or assigned.

Knowledge, Skills and Abilities:
Ability to identify customer needs and identify appropriate issue resolution.
Clear, concise and professional verbal and written communication skills.
Strong attention to detail.
Team Player.
Embodies the OneDigital Way: optimistic, personal, relentless, [uses] fresh-thinking, strategic.
Updating and using relevant insurance, HCR and ACA knowledge .
Strong time management skills and ability to multi-task.
Establishing and maintaining relationships with internal and external clients, carriers and team members.
Evaluating information to determine compliance with federal, state and corporate requirements and standards.
Proficient in Microsoft suite including Microsoft Word, Excel, and Outlook.
Ability to work any shift between the hours of 8am-8pm EST Monday-Friday with occasional overtime.

Proven track record in customer service with work output accuracy and strong production volume.
Carrier, Broker and/or insurance experience with active life/health license required (minimum college degree, or 10+ years of applicable experience will be considered).
Experience in complex claims processes, medical terminology and HCR/ACA.
HIPAA certificate required within 30 days of commencing role.
Spanish speaker/bi-lingual a plus.
Thank you for your interest in joining the OneDigital team!