Claims Advocate

ABOUT RIGHTWAY

Rightway is on a mission to harmonize healthcare for everyone, everywhere. Our products guide patients to the best care and medications by inserting clinicians and pharmacists into a patient’s care journey through a modern, mobile app. Rightway is a front door to healthcare, giving patients the tools they need along with on-demand access to Rightway health guides, human experts that answer their questions and manage the frustrating parts of healthcare for them.

Since its founding in 2017, Rightway has raised over $130mm from investors including Khosla Ventures, Thrive Capital, and Tiger Global at a valuation of $1 billion. We’re headquartered in New York City, with satellite offices in Miami and Denver. Our clients rely on us to transform the healthcare experience, improve outcomes for their teams, and decrease their healthcare costs.

RESPONSIBILITIES

• Determines coverage for medical, dental, and vision procedures by studying provisions of the member’s health policy
• Extracts additional information as required from outside sources, including claimant, physician, employer, hospital, insurance carriers and other third partners
• Initiates investigation of questionable claims
• Resolves medical, dental, and vision claim and billing questions and issues by
  • examining the summary of benefits
  • contacting the carrier and/or the provider billing office to ensure member is not being overcharged
  • calculating out-of-pocket costs based on benefits
  • initiating reimbursement requests with the carrier
  • composing appeal letter
• Provides information on year-to-date deductible, copay, and coinsurance activity to team members
• Maintains quality customer service by following customer service practices and responding to customer inquiries in a timely manner
• Protects claimant information by following HIPAA guidelines
• Reports claim status updates in proprietary CRM and provides detailed information of each claim
  

REQUIREMENTS

Our Navigation Operations is a fast-paced, dynamic, and a growing environment.  We are looking for individuals who are passionate about concierge service delivery and changing the healthcare experience for consumers.  This role will be office based, not a remote position. 

• Strong communication skills, both written and verbal
• Professional experience with both benefit plan interpretation, provider billing practices and claim adjudication
• Strong demonstration of critical thinking and problem solving skills
• Bachelor’s degree in health sciences or related field and minimum of 3 years of experience as medical claims specialist.

Expected hourly rate - $19-22/HR