Claims Specialist

West Corporation - Plymouth Meeting, PA (30+ days ago)3.3

Health Advocate is a leading provider of Advocacy and health benefits support. We have grown every year since our Launch in 2001. We continue to grow and provide health support solutions to our clients and members. Health Advocate offers a comprehensive training program and opportunities to grow your career learning multiple aspects of health benefit coverages and services.

We offer Great Benefits! The benefits package for this position includes very generous Paid Time Off (PTO), paid holiday policy, tuition reimbursement and a 401(k) with a match. Health Advocate has an on-site fitness facility, yoga classes, Employee Assistance Program, wellness programs, and employee activities to support employees with various goals.
Job Summary:
  • A Claims Specialist at Health Advocate is a dedicated service professional who understands benefit plans and wants to help members.
  • A successful candidate will work on the members’ behalf to understand claims adjudication guidelines and resolve medical billing issues for our membership.
  • It’s a rewarding position that encompasses investigation and communication skills
  • If you have previous health experience, this role may be a good fit for applying your current claims knowledge to truly help members
Essential Job Functions:
  • Handle some escalated and complex cases in a timely manner to identify opportunities to resolve the issue by working with plan documents, carriers, providers and member
  • Research plan information and identify where there may be conflicting information. Escalate as needed to supervisor or other levels of management for clarification and assistance
  • Research billing issues to determine the possible cause of the error, and assisting with claims re-submission when needed to correct the issue
  • Contribute to the development of policies and procedures to improve department workflow and the claims process
  • Negotiate payment plans and fee negotiations for complex and difficult cases
  • Serve as a resource of help to other claims specialists who need assistance and have questions on their cases
  • Heavily working with these resources to analyze and resolve billing issues:
    • Plan documents and plan benefits
    • Interpretation of benefits
    • Medical, dental, vision, behavioral health billing and claims adjudication
    • FSA, HRA and HSA plans
To be qualified, applicants will need:
  • Bachelor’s degree and/or 2-3 years claims experience
  • Strong research and analytical skills
  • Ability to work independently and escalate for assistance as needed
  • Strong communication ability to work with various internal and external parties to resolve member issues
  • Excellent organizational, time management, and customer service skills
  • Ability to proactively identify payer and provider trends, and to communicate this to management
  • Excellent listening skills and ability to emphasize with members
  • Excellent computer skills and experience in Microsoft Office Suite
We connect. We deliver. We are West.

EEO Employer

Job: Operations
Primary Location: United States-Pennsylvania-Plymouth Meeting

Organization: Health Advocate USA
Schedule: Full-time

Job Posting: 04/06/2018, 9:07:29 PM