About this role
Role Overview
- Resolve Complex Claims Issues: Investigate billing discrepancies, identify errors, and coordinate resolutions among members, carriers, and providers for timely claim processing.
- Coordinate Benefits Across Carriers: Manage cases involving Medicaid, Medicare, motor vehicle claims, and other benefit programs, ensuring proper coordination.
- Educate and Empower Members: Help members understand their benefit plans, educate them on coverage details, and guide them through challenging claims scenarios.
- Ensure Accuracy: Adhere to internal policies, procedures, and federal regulations to process claims in a precise and timely manner.
- Collaborate and Escalate: Partner with team members and escalate unresolved issues to supervisors or carriers when necessary.
- Support Team Growth: Mentor new team members, share best practices, and contribute to continuous process improvements.
Requirements
- You have at least 2 years of experience in healthcare, customer service, or claims.
- Familiarity with plan documents, ACA guidelines, Medicare, COBRA, and benefits such as dental, vision, and behavioral health is a plus.
- You’re proficient in MS Word and Excel and comfortable using internal databases to document and track cases.
- You excel at analyzing claims, identifying root causes, and proposing practical solutions.
- You possess strong listening skills and the ability to guide members with care and patience, even in complex or emotionally charged situations.
Benefits
- Competitive pay: Hourly pay rate starting at $20 per hour.
- Comprehensive Benefits: Enjoy competitive pay, robust medical, dental, and vision coverage, 401(k) with company match, PTO, and more.
- Tools for Success: Access advanced systems, comprehensive training, and the support of a collaborative team.
- A Culture of Care: Join a team that values empathy, innovation, and teamwork.