About the role
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