Claims & Benefits Specialist

(AHAs), and resolve complex claim, benefit, and eligibility issues by using internal resources, health plan carrier systems, and coordinating with our health plan partners.

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 frontline employees.

• 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 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.

• 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.

What we are looking for...

Required:

• High School Diploma/GED

• 3+ years of Health Plan or third party payor claims processing experience with a thorough understanding of health care delivery

• 2+ years experience with medical benefits and claims from either provider or payor perspective

• 2+ years working knowledge of various lines of business and applicable coding, (CPT, HCPCS, ICD-9/10, DRG, etc.)

• Skilled in verbal/written communication

Preferred:

• Bachelor's Degree

• Previous experience in roles where technology, multi-tasking and verbal/written communication is used to drive their day to day responsibilities

• Long-term job tenure in previous work experience for non-contract roles

• Strong workplace etiquette

Salary- $25/hr

Benefits

• Comprehensive medical, dental, vision, life, and disability benefits, including access to Accolade Advocacy, Accolade Care, and Accolade EMO.

• HDHP medical plan with generous employer contributions towards an HSA

• 401(k) Retirement Plan with matching employer contributions

• Open Time Off

• Generous Holiday Schedule + 5 floating holidays

• 18 weeks of paid parental leave

• Subsidized commuter benefits programs

• Virtual access to coaching, self-care activities, and video-based therapy and psychiatry through Ginger

• 1 Volunteer days per year

• Employee Stock Purchase Plan (ESPP) w/ employee discount

We strongly encourage you to be vaccinated against COVID-19.

Our people are the Heart of Accolade

Together, we are building a great and enduring business that truly makes an impact. At Accolade, we are committed to building a workplace where all can grow and thrive. We do this by living our core values:

Member Obsessed

For everything we do, we ask ourselves: Is this going to make our member's life measurably better?

Be Fearless

We think differently. We do what's never been done. We are reinventing healthcare every step of the way.

Stronger Together

We honor the differences among one another and know that our unique perspectives drive us forward.

Genuine Care

We care deeply about the human beings we work with and serve. We have each other's back.

Embrace Reality

We bring the data, tell the truth, and trust each other.

Relentless Execution

We operate with a bias for action. Take initiative, move fast & have fun.

Accolade is an Equal Opportunity and Affirmative Action Employer committed to advancing an inclusive environment for all qualified applicants and employees. We provide employment opportunities, without regard, to any legally protected status in accordance with applicable laws in the US. We are committed to help ensure you have a comfortable and positive interview experience.

Accolade, Inc., PlushCare, Inc., and Accolade 2ndMD LLC will never ask you to pay to get a job. Anyone who does this is a scammer. Further, we will never send you a check and ask you to send on part of the money or buy gift cards with it. These are also scams. If you see or lose money to a job scam, report it to the Federal Trade Commission at ReportFraud.ftc.gov. You can also report it to your state attorney general.

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RSRACC

Accolade