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Your primary objective is to provide effective and timely customer service for members, providers, insurers and clients regarding health care claims
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Ensure timely follow-up on requests for accounts to be reviewed
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Organize health insurance paperwork and medical record documentation
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Demonstrate knowledge of proprietary software and other required technology (Google apps, Slack, etc)
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Communicate timely status updates to patients throughout the claims process
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Negotiate with providers on plan member balances
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Appeal claim denials from the insurance company
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Contact providers and insurance companies to resolve claim concerns
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Assist with understanding of explanation of benefits (EOBs)
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Assisting members with resolving claim errors or denials. Ideally to recoup or lower their medical expenses
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Collaborate with peers and management across functions
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Understand the evolving business requirements and adapt the operational processes to meet those requirements
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Speak clearly, confidently and maintain professionalism as well as friendly member interactions while demonstrating persuasion in overcoming objections
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Ability to handle a fast-paced, dynamic environment with competing priorities
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Model a culture reflective of our core company values
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Gain and retain a thorough understanding of the team and company policies, processes, software, etc
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Including other duties and responsibilities as assigned by leadership
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1 year experience in customer service roles
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3 years of revenue cycle or carrier experience
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Passion for providing support
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Prior work experience in a claims support and health insurance role
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Ability to take meticulous notes and document actions taken
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Highly effective communication, problem resolution and organizational skills
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Demonstrated ability to meet goals in a rapidly changing environment
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Excellent data and overall analytical skills
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Excellent written and verbal communication skills
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Proven record of excellent time management and prioritization skills
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Ability to troubleshoot basic technical issues
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Proven track record of driving measurable efficiency results
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Medical billing/coding certification (CPC) is beneficial, but not required
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College degree preferred (additional experience in lieu of college degree will be considered)
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.