[Hiring] Claims Specialist @LanguageLine Solutions

Role Description

Join Us as a Claims Resolution Champion at Health Advocate, where we’re on a mission to simplify healthcare and empower our members to navigate their benefits confidently. If you’re ready to make a meaningful impact by resolving complex claims and advocating for those who need support, this is your chance to transform lives.

As a Claims Specialist, you’ll go beyond solving billing issues—you’ll serve as an advocate, educator, and problem-solver for our members. By leveraging your expertise in claims, benefits, and coordination of care, you’ll ensure timely resolutions that ease stress and deliver value. In this role, you’ll join a team that values collaboration, precision, and compassion.

What You’ll Do: Advocate, Resolve, Educate

• Resolve Complex Claims Issues: Investigate billing discrepancies, identify errors, and coordinate resolutions among members, carriers, and providers for timely claim processing.
• Coordinate Benefits Across Carriers: Manage cases involving Medicaid, Medicare, motor vehicle claims, and other benefit programs, ensuring proper coordination.
• Educate and Empower Members: Help members understand their benefit plans, educate them on coverage details, and guide them through challenging claims scenarios.
• Ensure Accuracy: Adhere to internal policies, procedures, and federal regulations to process claims in a precise and timely manner.
• Collaborate and Escalate: Partner with team members and escalate unresolved issues to supervisors or carriers when necessary.
• Support Team Growth: Mentor new team members, share best practices, and contribute to continuous process improvements.

Qualifications

• At least 2 years of experience in healthcare, customer service, or claims.
• Strong analytical skills for identifying root causes and proposing practical solutions.
• Strong listening skills and the ability to guide members with care and patience.
• Familiarity with plan documents, ACA guidelines, Medicare, COBRA, and benefits such as dental, vision, and behavioral health is a plus.
• Proficient in MS Word and Excel and comfortable using internal databases.

Requirements

• A private, HIPAA-compliant workspace where confidential member information cannot be viewed or overheard by others.
• Sufficient desk space to accommodate a dual-monitor workstation and related equipment.
• Reliable high-speed internet with a minimum download speed of 200 Mbps.
• The ability to work in a professional, distraction-free environment during scheduled work hours.

Benefits

• Purpose-driven work that makes a real difference in members' lives.
• Access to advanced systems, comprehensive training, and the support of a collaborative team.
• Competitive pay starting at $18.00 per hour.
• Comprehensive benefits including robust medical, dental, and vision coverage, 401(k) with company match, PTO, and more.
• A culture that values empathy, innovation, and teamwork.

Company Description

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.