[Hiring] Claims Support Advocate @Included Health

Role Description

As a Claims Support Advocate (CSA), you will be part of a vibrant team of high performing and highly engaged professionals that work to ensure a quality member experience within our service level agreements. The CSA serves as a liaison between plan members, providers and health insurance companies to resolve member claim inquiries. The CSA handles all communication, paperwork, and negotiations with a health insurance carrier or provider on the behalf of the plan member.

• Your primary objective is to provide effective and timely customer service for members, providers, insurers and clients regarding health care claims.
• Ensure timely follow-up on requests for accounts to be reviewed.
• Organize health insurance paperwork and medical record documentation.
• Demonstrate knowledge of proprietary software and other required technology (Google apps, Slack, etc).
• Communicate timely status updates to patients throughout the claims process.
• Negotiate with providers on plan member balances.
• Appeal claim denials from the insurance company.
• Contact providers and insurance companies to resolve claim concerns.
• Assist with understanding of explanation of benefits (EOBs).
• Assist members with resolving claim errors or denials, ideally to recoup or lower their medical expenses.
• Collaborate with peers and management across functions.
• Understand the evolving business requirements and adapt the operational processes to meet those requirements.
• Speak clearly, confidently and maintain professionalism as well as friendly member interactions while demonstrating persuasion in overcoming objections.
• Ability to handle a fast-paced, dynamic environment with competing priorities.
• Model a culture reflective of our core company values.
• Gain and retain a thorough understanding of the team and company policies, processes, software, etc.
• Including other duties and responsibilities as assigned by leadership.

Qualifications

• 1 year experience in customer service roles.
• 3 years of revenue cycle or carrier experience.
• Passion for providing support.
• Prior work experience in a claims support and health insurance role.
• Ability to take meticulous notes and document actions taken.
• Highly effective communication, problem resolution and organizational skills.
• Demonstrated ability to meet goals in a rapidly changing environment.
• Excellent data and overall analytical skills.
• Excellent written and verbal communication skills.
• Proven record of excellent time management and prioritization skills.
• Ability to troubleshoot basic technical issues.
• Proven track record of driving measurable efficiency results.
• Medical billing/coding certification (CPC) is beneficial, but not required.
• College degree preferred (additional experience in lieu of college degree will be considered).

Requirements

• The hourly pay for this full time, contract position is $22.08 per hour in the United States.
• This posted range reflects the portion of our internal pay band that is currently funded for new hires in this role across our standard labor markets (Zones A–C).
• For context, these markets include:
• Zone A (e.g., Phoenix AZ, San Antonio TX, Columbus OH, Charlotte NC).
• Zone B (e.g., Chicago IL, Denver CO, San Diego CA, Houston TX).
• Zone C (e.g., Los Angeles CA, Seattle WA, Washington, D.C., Boston MA).
• At this time, we are not budgeting for hires in higher-cost Zone D markets (e.g., San Francisco Bay Area CA, New York City NY, San Jose CA) for this role.
• Within this range, individual pay is determined by work location, skills, experience, and internal equity.
• We use structured pay bands and geographic zones based on cost of labor to keep pay fair and consistent.

Company Description

Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical.

• We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care.
• It’s all included. Learn more at includedhealth.com.