Claims Advocacy Specialist I

Summary

Join Included Health as a Claims Advocacy Specialist and play a pivotal role in managing complex member claims escalations. You will collaborate with internal and external teams to resolve issues efficiently and accurately. You will research operational challenges, identify areas for improvement, and contribute to enhancing the claims experience. The ideal candidate is curious, a quick learner, and able to work independently and collaboratively. This individual contributor role reports to the Manager of Claims Advocacy and requires a passion for problem-solving and delivering exceptional customer service.

Requirements

• 2+ years experience in claims processing or revenue cycle management
• Mastery of de-escalation techniques and customer service
• Show initiative to identify and solve issues at scale
• Manage multiple priorities with strong decision-making ability
• Highly organized and able to work with minimal supervision
• Demonstrates high levels of emotional intelligence and empathy
• Curious nature- wanting to dig in and understand root causes of problem
• Experience working cross-functionally
• Strong written and verbal communication skills
• Ability to adapt to a changing environment
• Prompt and regular attendance at assigned work location
• Ability to remain seated in a stationary position for prolonged periods
• Requires eye-hand coordination and manual dexterity sufficient to operate keyboard, computer and other office-related equipment
• No heavy lifting is expected, though occasional exertion of about 20 lbs. of force (e.g., lifting a computer / laptop) may be required
• Ability to interact with leadership, employees, and members in an appropriate manner

Responsibilities

• Research escalations originating from members, clients and/or client success
• Collaborate with internal (e.g. Quality) and external partners (e.g. carriers) to ensure claims escalations are resolved and responded-to within defined turn-around-times
• Create action plans to address widespread issues raised by member feedback
• Drive improvements through developing strategic contacts and internal collaboration
• Assist with process-development and problem-solving with external vendors and carriers
• Draft Job Aids to support new initiatives
• Manage SOPs to reflect most current directives
• Mentor team members for performance improvements
• Train new hires and assist in onboarding process
• Provide team support for complex scenarios and finding resolutions
• Collate member impact stories for newsletter, marketing and team impact as needed
• Support team morale through difficult cases and adversity