Claims Support Advocate (Temp)

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

  Qualifications:  

• 1 year experience in customer service roles

• 3 years of revenue cycle or carrier experience

• Passion for providing support

• Prior work experience in a claims support and health insurance role

• Ability to take meticulous notes and document actions taken

• Highly effective communication, problem resolution and organizational skills

• Demonstrated ability to meet goals in a rapidly changing environment

• Excellent data and overall analytical skills

• Excellent written and verbal communication skills

• Proven record of excellent time management and prioritization skills

• Ability to troubleshoot basic technical issues

• Proven track record of driving measurable efficiency results

• Medical billing/coding certification (CPC) is beneficial, but not required

• College degree preferred (additional experience in lieu of college degree will be considered)

  The hourly pay for this full time, contract position is $22.08 per hour in the United States. This posted range reflects the portion of our internal pay band that is currently funded for new hires in this role across our standard labor markets (Zones A–C). 

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.

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

  Qualifications:  

• 1 year experience in customer service roles

• 3 years of revenue cycle or carrier experience

• Passion for providing support

• Prior work experience in a claims support and health insurance role

• Ability to take meticulous notes and document actions taken

• Highly effective communication, problem resolution and organizational skills

• Demonstrated ability to meet goals in a rapidly changing environment

• Excellent data and overall analytical skills

• Excellent written and verbal communication skills

• Proven record of excellent time management and prioritization skills

• Ability to troubleshoot basic technical issues

• Proven track record of driving measurable efficiency results

• Medical billing/coding certification (CPC) is beneficial, but not required

• College degree preferred (additional experience in lieu of college degree will be considered)

  The hourly pay for this full time, contract position is $22.08 per hour in the United States. This posted range reflects the portion of our internal pay band that is currently funded for new hires in this role across our standard labor markets (Zones A–C). 

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.

About Included Health
Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It’s all included. Learn more at includedhealth.com.
-----Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants with arrest or conviction records in accordance with the San Francisco Fair Chance Ordinance, the Los Angeles County Fair Chance Ordinance, and California law.