Job Description

ROLE OVERVIEW

The Claims and Benefit Specialist you will work to provide Accolade Health Assistants (AHAs) accurate and timely resolution to their clients’ problems while coaching AHAs and improving their claims and coverage knowledge.  In addition, you will continuously evaluate trends, content and processes and make recommendations to fix or improve them. This job requires deep claims and benefit knowledge, critical thinking, creative problem solving, the consistent application of discretion and good judgment, a high degree of organization, the ability to multi-task, and the ability to develop strong health plan partner relationships.  

A DAY IN THE LIFE…

• Act as a trusted resource for complex claims and benefit questions and issue resolution.  
• Act as a liaison to our health plan partners and providers in solving complex claims and benefit issues.
• Educate AHAs by helping them better understand claims and benefit questions/issue resolution, and support ongoing training/learning with the Health Assistant Center (HAC).
• Collaborate with Accolade teammates, health plans, and providers to deliver the best possible service experience for Accolade clients.
• Handle claim disputes with partner health plans on behalf of the client
  • Ensure compliance with internal and external health plan partner business processes.
  • Develop and maintain solid working relationships and processes with health plans and other payors.
• Support AHAs with eligibility, benefits, and claims questions and/or issue resolution, including understanding the root cause of the issue Handle claims disputes with partner health plans on behalf of the client. Handle claim disputes with partner health plans on behalf of the client
  • Listen, assess, and comprehend the clients’ presenting issue(s) and use critical thinking, judgment, and problem solving to take appropriate action.
• Identify opportunities to improve how we resolve claims and benefit issues, including improvements to MRM (our customized service platform), our benefit content, and other tools and resources.
• Leveraging your industry knowledge and influencing skills, encourage future collaboration with health plans and providers.
• Participate in special projects as requested
• Provide colleagues with timely and accurate solutions to their client’s complex claims problems.
• Effectively manage an ongoing portfolio of claims/benefits issues, ensuring timely, complete and accurate resolution in support of client expectations and health plan processing guidelines.

Qualifications

WHAT WE ARE LOOKING FOR…

• A thorough understanding of health care delivery and previous experience with medical benefits (primarily self-insured plans) and claims from either provider or payor perspective.

  • 3 to 4 years of Health Plan or third party payor claims processing experience with strong technical skills (business expertise) and knowledge of various lines of business and applicable coding (CPT, HCPCS, ICD-9/10, DRG, etc.)
  • Health Plan business/benefit analyst with an emphasis on claims coding (see above line) and benefit set-up
  • Health Plan claims quality assurance
  • Practice Management or Hospital –Familiar with all bill types and national account billing

• Engage others by being a good listener with a solid capacity for empathy.

• Possess excellent communication skills and the ability to convey passion and enthusiasm.

• Possess superior ingenuity, judgment and problem solving skills.

• Partner/work with teammates to solve issues for clients.

• Organized, dependable and meticulous.

• Flexible with a high tolerance for ambiguity.

• The ability for self-reflection and the capacity to accept and implement feedback.

• Must be computer literate at an intermediate or advanced level.

• Must display honesty and integrity.

• Must be comfortable working in a telephonic environment with clients, health plans, and providers.

• COVID 19 

  VACCINATION & OFFICE POLICY

  At this time, Accolade’s offices are open to vaccinated employees only, subject to

  limited exceptions, for the safety and wellbeing of our staff.

  Most onboarding training is conducted in our offices, but virtual onboard trainings are occasionally conducted at our discretion.

  People & Culture will ask your vaccination status in order to properly prepare

  training classes and protocols, accordingly.

Additional Information

WHAT IS IMPORTANT TO US

Creating an enduring company that is hyper-focused on our culture and making a meaningful impact in the lives of our employees, members and customers. The secret to our success is:

WE FIND JOY AND PURPOSE IN SERVING OTHERS

Making a difference in our members’ and customers’ lives is what we do.  Even when it’s hard, we do the right thing for the right reasons.

WE ARE STRONG INDIVIDUALLY AND TOGETHER, WE’RE POWERFUL

Trusting in our colleagues and embracing their different backgrounds and experiences enable us to solve tough problems in creative ways, having fun along the way.

WE ROLL UP OUR SLEEVES AND GET STUFF DONE

Results motivate us. And we aren't afraid of the hard work or tough decisions needed to get us there.

WE’RE BOLDLY AND RELENTLESSLY REINVENTING HEALTHCARE

We're curious and act big - not afraid to knock down barriers or take calculated risks to change the world, one person at a time.

*All your information will be kept confidential according to EEO guidelines.