Claims Support Coordinator
Member Care – Member Care /
As a Claims Support Coordinator, you will be part of a vibrant team of high performing and highly engaged professionals that work to ensure a quality patient experience within our service level agreements. The Claims Support Coordinator role serves as a liaison between plan members, providers and health insurance companies to get claims issues resolved. The Claims Support 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, insurer 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, etc)
- Negotiate with providers on plan member balances
- Challenge denials of claims by the insurance company
- Communicate with medical offices, hospitals, laboratories, etc... in an effort to obtain relevant records for the patient’s case
- Contact providers and insurance companies to resolve claim concerns
- Assist with understanding of explanation of benefits (EOBs)
- Enabling members to get the errors fixed and recoup or lower their expenses by resolving their: medical bills, denied medical claims, medical letters of appeal
- Analyze and identify trends and patterns related to member billing complaints
- 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 have a friendly phone demeanor while demonstrating persuasion in overcoming objections
- Be able to handle a fast-paced dynamic environment with competing priorities
- Model a culture reflective of our Core Company Values; gain and maintain a thorough understanding of the Patient Care Team policies, processes, software, etc.
- Minimum 3 years Claims experience strongly preferred
- Hospital Claims experience strongly preferred
- Highly effective communication, problem resolution and organizational skills
- Demonstrated ability to meet goals in a rapidly changing environment
- Excellent data and overall analytical skills
- Proven track record of driving measurable efficiency results
- Knowledge of medical terminology, ICD-9/ICD-10, CPT and DRG coding a plus.
- College degree preferred (additional experience in lieu of college degree will be considered)
About Included Health
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.
Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants in accordance with the San Francisco Fair Chance Ordinance.