Claims & Benefits Service Representative

About Accolade
Accolade (Nasdaq: ACCD) provides millions of people and their families with an exceptional healthcare experience that is personal, data driven and value based to help every person live their healthiest life. Accolade solutions combine virtual primary care, mental health support and expert medical opinion services with intelligent technology and best-in-class care navigation. Accolade's Personalized Healthcare approach puts humanity back in healthcare by building relationships that connect people and their families to the right care at the right time to improve outcomes, lower costs and deliver consumer satisfaction. Accolade consistently receives consumer satisfaction ratings over 90%. For more information, visit accolade.com .
Role overview
Claims & Benefit Specialists primarily work inbound tasks and instant messages from our Accolade Health Assistants (AHAs), and resolve complex claim, benefit, and eligibility issues by using internal resources, health plan carrier systems, and coordinating with our health plan partners.
A day in the life...

• Act as a trusted resource for complex claims and benefit questions and issue resolution.
• Act as a liaison to our health plan partners and providers in solving complex claims and benefit issues.
• Educate AHAs by helping them better understand claims and benefit questions/issue resolution and support ongoing training/learning with frontline employees.
• Collaborate with Accolade teammates, health plans, and providers to deliver the best possible service experience for Accolade clients.
• Handle claim disputes with partner health plans on behalf of the client
• Ensure compliance with internal and external health plan partner business processes.
• Develop and maintain solid working relationships and processes with health plans and other payors.
• Support AHAs with eligibility, benefits, and claims questions and/or issue resolution, including understanding the root cause of the issue
• Handle claim disputes with partner health plans on behalf of the client.
• Listen, assess, and comprehend the clients' presenting issue(s) and use critical thinking, judgment, and problem solving to take appropriate action.
• Identify opportunities to improve how we resolve claims and benefit issues, including improvements to MRM (our customized service platform), our benefit content, and other tools and resources.
• Leveraging your industry knowledge and influencing skills, encourage future collaboration with health plans and providers.
• Participate in special projects as requested
• Provide colleagues with timely and accurate solutions to their client's complex claims problems.
• Effectively manage an ongoing portfolio of claims/benefits issues, ensuring timely, complete and accurate resolution in support of client expectations and health plan processing guidelines.
• Provide colleagues with timely and accurate solutions to their client's complex claims problems.
• Effectively manage an ongoing portfolio of claims/benefits issues, ensuring timely, complete and accurate resolution in support of client expectations and health plan processing guidelines.

What we are looking for...
Required:

• High School Diploma/GED
• 3+ years of Health Plan or third party payor claims processing experience with a thorough understanding of health care delivery
• 2+ years experience with medical benefits and claims from either provider or payor perspective
• 2+ years working knowledge of various lines of business and applicable coding, (CPT, HCPCS, ICD-9/10, DRG, etc.)
• Skilled in verbal/written communication

Preferred:

• Bachelor's Degree
• Previous experience in roles where technology, multi-tasking and verbal/written communication is used to drive their day to day responsibilities
• Long-term job tenure in previous work experience for non-contract roles
• Strong workplace etiquette

We strongly encourage you to be vaccinated against COVID-19.
What is important to us...
Creating an enduring company that is hyper-focused on our culture and making a meaningful impact in the lives of our employees, members and customers. The secret to our success is:
We find joy and purpose in serving others
Making a difference in our members' and customers' lives is what we do. Even when it's hard, we do the right thing for the right reasons.
We are strong individually and together, we're powerful
Trusting in our colleagues and embracing their different backgrounds and experiences enable us to solve tough problems in creative ways, having fun along the way.
We roll up our sleeves and get stuff done
Results motivate us. And we aren't afraid of the hard work or tough decisions needed to get us there.
We're boldly and relentlessly reinventing healthcare
We're curious and act big -- not afraid to knock down barriers or take calculated risks to change the world, one person at a time.
Accolade is an Equal Opportunity and Affirmative Action Employer committed to advancing an inclusive environment for all qualified applicants and employees. We provide employment opportunities, without regard, to any legally protected status in accordance with applicable laws in the US. We are committed to help ensure you have a comfortable and positive interview experience.
Accolade, Inc., PlushCare, Inc., and Accolade 2ndMD LLC will never ask you to pay to get a job. Anyone who does this is a scammer. Further, we will never send you a check and ask you to send on part of the money or buy gift cards with it. These are also scams. If you see or lose money to a job scam, report it to the Federal Trade Commission at ReportFraud.ftc.gov . You can also report it to your state attorney general.
To review our policy around data use, visit our Accolade Privacy Policy Page . All your information will be kept confidential according to EEO guidelines.
RSRACC
Accolade