Medical Cost Negotiator & Claims Specialist

Why is Health Advocate a great place to work? For starters, Health Advocate employees enjoy helping people every single day. Employees are given the training they need to do their jobs well, and they work with supervisors and staff who are supportive and friendly. Employees have room to grow, and many of Health Advocate's supervisors are promoted from within the company. Join our award winning team!



2023 Awards:

• National Customer Service Association All-Stars Award: Service Organization of the Year.


• Stevie Awards for Sales & Customer Service: Customer Service Department of the Year - Healthcare, Pharmaceuticals, and Related Industries, Bronze Winner

Basic Function


At Health Advocate, we are committed to providing our customers with expertise and services that improve the health, well-being and productivity of their employees. We are looking for the right person to: work with medical providers to negotiate balances outstanding on member’s claims


The appropriate candidate would be responsible for managing multiple claims cases, interfacing with internal staff and external providers to understand and negotiate claims balances. The appropriate candidate will follow up to ensure all aspects of the negotiation are documented and processed for member satisfaction



Major Accountabilities

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  Handles Member calls & cases for claims fee negotiation
  


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  Negotiates Consumer/Member Medical Claims with Healthcare Providers
  


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  Send and Acknowledge receipt of Contracts from Consumers/Members and Providers
  


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  Tracks all Settlements
  


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  Reports Settlement results within the system and Statistics to Management
  


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  Works with other Health Advocate units, including training when requested
  


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  Works with product development VP to refine process and improve the Consumer/Member Settlement product
  


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  Supports Sales & Marketing as SME, including participation in meetings with Current and Prospective Customers
  


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  Provide benefit and claims consultation and support when appropriate to all internal departments
  


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  Effective communication skills to interact with members, physicians, and insurance carrier representatives, with an emphasis on ability to communicate both verbally and in writing
  


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  Assertive, self-confident, and resilient
  


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  Ability to search and identify resources through the internet
  


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  Demonstrated ability to communicate concepts, strategies and plans in terminology understood by business professionals
  


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  Ability to interpret Explanation of Benefits (EOBs)
  


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  Familiarity with various types of health insurance coverage, coordination of benefits, and UCR fees
  

Claims Research Assistance

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  Assist in resolving routine program quality issues by identifying issue(s) and researching in a timely manner
  


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  Research and evaluate billing issues to determine the possible cause of the error ensuring to assist the client with claims resubmission correct the issue
  


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  As needed, contact healthcare providers to gather documentation (e.g., bills, medical records, etc.) ensuring to notify management if the request cannot be obtained
  


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  Follow claims research through until resolution
  


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  Document all claims issues thoroughly maintaining department files and appropriate databases
  


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  Continuously evaluate the status of all work efforts, ensuring all tasks are prioritized to assist in providing timely and quality services
  


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  Assist in monitoring issue trends, escalating such trends to supervisor to determine appropriate actions necessary to eliminate future occurrences and improve service levels
  

Team Interfaces/Customer Service

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  Establish and maintain a professional relationship with internal/external customers, team members and department contacts
  


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  Cooperate with team members to meet goals or complete tasks
  


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  Provide quality customer service that exceeds customer expectations and improves level of service being provided
  


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  Treat all internal/external customers, team members and department contacts with dignity/respect
  


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  Escalate to supervisor any situation outside the employee's control that could adversely impact the services being provided
  

Mental and Physical Requirements

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  This position will be exposed mainly to an indoor office environment and will be expected to work near or around computers, telephones, and printers with a workspace that is free and clear of interruptions and distractions
  


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  The nature of the work in this position is sedentary and the incumbent will be sitting most of the time
  


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  Essential physical functions of the job include fingering, grasping, pulling hand over hand, and repetitive motions to utilize general computer software/hardware continuously throughout the work day
  


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  Essential mental functions of this position include concentrating on tasks, reading information, and verbal/written communication to others continuously throughout the work day
  

Related Duties as Assigned

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  The job description documents the general nature and level of work but is not intended to be a comprehensive list of all activities, duties, and responsibilities required of job incumbents
  


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  Consequently, job incumbents may be asked to perform other duties as required
  


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  Also note, that reasonable accommodations may be made to enable individuals with disabilities to perform the functions outlined above
  


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  Please contact your local Employee Relations representative to request a review of any such accommodations
  

MINIMUM QUALIFICATIONS


Education

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  High School Degree or GED required
  


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  Associate degree from an accredited college or university with major course work in business administration, liberal arts, public health, healthcare management, or a related field preferred
  

Experience

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  Minimum of four years customer service, healthcare, or claims experience required
  

Other

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  Basic Knowledge of MS Word and Excel required
  


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  Must score acceptably on job related testing
  


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  Ability to pass standardized interview
  


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  Based on program may need to be bilingual in English, Spanish, etc
  

Knowledge of the following is preferred:

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  Affordable Care Act (ACA) (Marketplace Navigation and Exchange plan review and comparison)
  


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  Consolidated Omnibus Budget Reconciliation Act (COBRA)
  


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  Medicare (Part A, Part B, Part D, Advantage and MediGap Plans)
  


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  Compare and contrast benefit plan options (Open Enrollment, New Hire, Qualifying Life Event (QLE), and other Special Enrollment Periods)
  


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  Group Benefits (Fully Insured vs. Self-Insured)
  


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  Medical Benefits (CDHP/HDHP, PPO, POS, and HMO Plans)
  


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  Pharmacy Benefits
  


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  Dental Benefits
  


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  Behavioral Health Benefits
  


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  Vision Benefits
  


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  FSA/HSA and HRA Benefits
  


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  Long Term and Short Term Disability and Long Term Care
  


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  Individual Health Plans
  


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  Short Term Plans
  

Company Overview



Health Advocate is the nation’s leading provider of health advocacy, navigation, well-being and integrated benefits programs. For 20 years, Health Advocate has provided expert support to help our members navigate the complexities of healthcare and achieve the best possible health and well-being. Our solutions leverage a unique combination of best-in-class, personalized support with powerful predictive data analytics and a proprietary technology platform to address nearly every clinical, administrative, wellness or behavioral health need. Whether facing common issues or an unprecedented challenge like COVID-19, our team of highly trained, compassionate experts work together to go above and beyond expectations, making healthcare easier for our members and ensuring they get the care they need


Learn more


Health Advocate

https://www.healthadvocate.com/site/





Awards:


2023:

• National Customer Service Association All-Stars Award: Service Organization of the Year.


• Stevie Awards for Sales & Customer Service: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries, Bronze Winner

2022:

• Stevie Awards for Sales & Customer Service: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries, Bronze Winner


• Excellence in Customer Service Awards: Organization of the Year (Small)


• Best in Biz Awards: Most Customer-Friendly Company of the Year – Medium and large category (Silver)

2021:

• Stevie Awards for Sales & Customer Service: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries, Silver Winner


• Stevie Awards for Sales & Customer Service: Most Valuable Response by a Customer Service Team (COVID-19). Bronze Winner


• Best in Biz Awards: Most Customer-Friendly Company of the Year – Medium and large category (Silver)

2020:

• National Customer Service Association All-Stars Award: Organizations of 100 or Greater, Runner-Up


• Communicator Award of Distinction: October 2019 Broker News


• MarCom Awards: Gold, COVID Staycation Ideas brochure


• MarCom Awards: Platinum, 2021 Well-being Calendar


• Best in Biz Awards: Most Customer-Friendly Company of the Year - Medium category (Silver)

Health Advocate is an Equal Opportunity Employer that does not discriminate on the basis of race, color, sex, age, religion, national origin, citizenship status, military service and veteran status, physical or mental disability, or any other factor not related to job requirements. We respect and value diversity, and are committed to the principles of Equal Employment Opportunity



VEVRAA Federal Contractor requesting appropriate employment service delivery systems, such as state workforce agencies and local employment delivery systems, to provide priority referrals of protected veterans


PAY TRANSPARENCY NONDISCRIMINATION PROVISION



The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-I.35(c)