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Healthcare Claims Advocate (Alight Solutions)

Healthcare Claims Advocate (Alight Solutions)

Requisition ID 
2429194
Job Locations 
US-TX-The Woodlands
Job Family 
Benefits Service Delivery

Responsibilities

Alight Solutions (formerly Aon Hewitt)  Is Looking For a Heathcare Claims Advocate!

 

As part of an industry-leading team, you will help empower results for our clients by delivering innovative and effective solutions as part of our Advocacy business group within Aon Hewitt, in The Woodlands, TX.  This position supports Alight Solutions benefits administration and HR BPO platform businesses. 

 

Detailed Responsibilities

  • Handle incoming complex calls offering compassion and empathy while using exceptional listening skills to identify the customer’s needs.
  • Identify the health insurance needs of customers, accurately answer questions, address concerns, and recommend an appropriate plan
  • Provide accurate information to customers regarding the Affordable Care Act (ACA)
  • Actively listen to identify custom needs by utilizing probing questions
  • Resolve customer needs or concerns related to:
    • identification of in-network providers or physician specialists
    • delay or denial of treatment
    • claims  processed or denied incorrectly
    • clarification and education on general or specific benefit plans or programs
    • resolution of prescription / drug access or cost issues
    • coordinate access to clinical support for education regarding a diagnosis or treatment plan
    • specialty services for complex treatment plans
  • Full accountability for research and resolution of the customer’s issue including bring in additional resources and communicating final resolution.
  • Review specific employer plan provisions pertinent to resolving customer  questions or concerns
  • Investigate identified issue by interacting with the health plan, provider, and other third parties as needed.
  • Confidently educate customer by being proficient with all employer health benefit tools and resources
  • Refer customers to broader employer programs and available tools
  • Make outbound/follow-up calls, to provide resolution, to the issue by sharing requested information, educating the customer on how a benefit ‘works’ or referring them to a program for additional support.
  • Document all research and summarize calls in the case management system  
  • Become a resource and/or subject matter expert for your aligned employers
  • Deliver a consistently positive customer experience in a highly ethical and professional manner
  • Identify learnings/trends and provide recommended ideas/solutions to share back with the broader customer service team
  • Identify barriers for customers attempting to access care

Competencies, Knowledge & Experience

Education & Certification

3 years relevant experience in health plan benefits

OR 2 year degree in a health related field

 Must have current certification:

  • In Illinois Health and Accident License and/or Life License and/or
  • In Texas Life, Accident, Health & HMO License

Work Experience

  • Detailed knowledge of health benefits, including PPO plans, High deductible, HSAs and HRAs,
  • Understanding of specific plan coverages and exclusions in medical, prescription, dental, vision, and behavioral health/substance abuse
  • Preferred knowledge or experience in at least one of the following:
    • Affordable Care Act
    • Medical claim handling, processing and billing
    • Health Savings Account
    • Carrier & medical provider interactions
    • Carrier case management
    • COBRA
  • Proven track record of health care insurance and/or commercial insurance sales
  • Experience with desktop/Windows navigation and keyboarding skills.
  • Experience with MS Word, Excel, SharePoint, and Outlook
  • Specialty services like transgender, autism and/or infertility

 

Qualifications

  • Aptitude for understanding details of health insurance products and compliance with all regulations
  • Exceptional listening skills
  • Excellent customer service expertise, with both email interactions and on the phone
  • Problem solving, critical thinking, and analytical skills
  • Strong organizational and time management proficiencies
  • Flexible and adaptable with a demonstrated ability to recognize the need to change priorities to meet the business needs.
  • Ability to work independently while providing support in a team environment
  • Strong written and verbal communication skills
  • Ability to execute thorough and detailed documentation

Other

Work Conditions  

  • Frequent computer use at a workstation for extended periods of time.
  • Access information using a computer and related components and peripherals.
  • Participate in training sessions and meetings.
  • Ability to be flexible with various shifts and possible overtime when business needs require.
  • Ability to coordinate phone time including making outbound calls and receiving inbound calls consecutively throughout the day

 

We offer you

A competitive total rewards package, continuing education & training, and tremendous potential with a growing worldwide organization.

 

Our Colleague Experience

At Alight Solutions, we are reimaging how people and organizations thrive. To deliver on this purpose, we do things differently. From company leaders to our newest colleagues, we all play a role in bringing our values to life. Every colleague shapes how Alight can become better, stronger and brighter – together. With technology as our catalyst and humanity at our core, we advance each day toward a better future in work and life.

 

About Alight Solutions

As the leading provider of benefits administration and cloud-based HR and financial solutions, we enhance work and life through our service, technology and data. Our 22,000 colleagues across 14 global centers deliver an unrivaled consumer experience for our clients and their people. We are Alight. Reimagining how people and organizations thrive.

 

By applying for a position with Alight, you understand that, should you be made an offer, it will be contingent on your undergoing and successfully completing a background check consistent with Alight’s employment policies. Background checks may include some or all of the following based on the nature of the position: SSN/SIN validation, education verification, employment verification, and criminal check, search against global sanctions and government watch lists, fingerprint verification, credit check, and/or drug test.  You will be notified during the hiring process which checks are required by the position.

 

Alight Solutions provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, creed, sex, sexual orientation, gender identity, national origin, age, disability, genetic information, pregnancy, childbirth or related medical condition, veteran, marital, parental, citizenship, or domestic partner status, or any other status protected by applicable national, federal, state or local law.  Alight Solutions is committed to a diverse workforce and is an affirmative action employer.

 

DISCLAIMER:

Nothing in this job description restricts management's right to assign or reassign duties and responsibilities of this job to other entities; including but limited to subsidiaries, partners, or purchasers of Alight business units. 

 

 

 

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