Health Advocate

Claims Specialist

• Investigate billing discrepancies, identify errors, and coordinate resolutions among members, carriers, and providers
• Manage cases involving Medicaid, Medicare, motor vehicle claims, and other benefit programs
• Educate members on benefit plans and coverage details
• Adhere to internal policies, procedures, and federal regulations when processing claims
• Collaborate with team members and escalate unresolved issues to supervisors or carriers
• Mentor new team members and share best practices
• Contribute to continuous process improvements
• Document and track cases using internal databases

General

• Apply cash to open receivables with 100% accuracy and maintain documentation
• Use appropriate third-party payment software to process payments daily
• Research and resolve payments without posting instructions within assigned scope
• Reconcile accounts receivable batches to bank deposits
• Contact customers regarding payment discrepancies as necessary
• Coordinate with supervisors and coworkers to meet deadlines
• Monitor and respond to inquiries sent to the AR email
• Process refunds to clients and brokers
• Process returned payments in third-party software and contact clients regarding returned payments
• Perform other duties as assigned

Cash Application Specialist

Advocate

• Receive inbound member calls about healthcare issues including infertility, chronic disease, medications, and diagnoses
• Assess member needs and determine appropriate actions according to policies, procedures, and KPIs
• Take ownership of member cases and encourage continued engagement
• Educate members about medical conditions, diagnostic testing, test results, and treatment options
• Explain complex medical and benefit information clearly and compassionately
• Provide healthcare provider and service options based on clinical needs, geographic location, and benefit coverage
• Research providers through credentialing, education verification, and medical-center affiliations
• Facilitate communication between members, physicians, and insurance carriers
• Assist with appointments, medical-record transfers, access issues, and benefit provisions
• Intercede to obtain earlier appointments or remove barriers to care
• Support members with prescriptions, pre-service fee negotiations, and authorization challenges
• Maintain accurate and timely case documentation
• Place outbound follow-up calls and respond to delegate box, answer service, and after-hours calls
• Escalate cases to supervisors or internal clinical resources
• Stay current on patient care procedures, diagnoses, authorizations, denials, and healthcare practices
• Mentor new team members and collaborate with colleagues to maintain service excellence
• Establish professional relationships with internal and external customers and meet departmental goals

Personal Health Advocate

Administrative Assistant

• Provide administrative support to department staff
• Perform report creation, word processing, phone coverage, and other administrative functions
• Prioritize work based on timelines
• Provide phone coverage
• Process affiliate invoices for timely payment
• Gather data from various systems and compile reports
• Work on projects using Word, Excel, PowerPoint, and similar tools
• Compose meeting minutes and disseminate them to appropriate parties
• Perform other duties as assigned

Claims Specialist

Cash Application Specialist

Personal Health Advocate

Seasonal Administrative Assistant – 6-Month Assignment