Claims & Benefits Specialist I

About Transcarent
Transcarent and Accolade have come together to create the One Place for Health and Care, the leading personalized health and care experience that delivers unmatched choice, quality, and outcomes. Transcarent’s AI-powered WayFinding, comprehensive Care Experiences – Cancer Care, Surgery Care, Weight – and Pharmacy Benefits offerings combined with Accolade’s health advocacy, expert medical opinion, and primary care, allows us to meet people wherever they are on their health and care journey. Together, more than 20 million people have access to the combined company’s offerings. Employers, health plans, and leading point solutions rely on us to provide trusted information, increase access, and deliver care.

Claims & Benefit Specialists primarily work inbound tasks and instant messages from our Care Advocats, 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 Care Advocates 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 Care Advocates 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

The pay for this position is $25/hr

At Transcarent/Accolade, we are committed to compensation practices that are fair, competitive, and aligned with our mission to support every person’s ability to thrive — at work and in life. The final base pay offered within the posted range is determined based on a candidate’s job-related knowledge, skills, and experience, as well as internal equity and market competitiveness relative to geographic location. In the United States, we use three geographic pay zones to help guide equitable and market-aligned compensation decisions. Depending on the role, offers may also include additional forms of compensation such as short-term and long-term incentives (bonuses, equity, etc.) alongsi