Claims & Benefits Specialist
Company: Accolade, Inc.
Posted on: November 22, 2021
Accolade is a personalized health and benefits solution that
dramatically improves the experience, outcomes and cost of
healthcare for employers, health plans and their members. With a
unique blend of compassionate advisors, clinical experts and
intelligent technologies, we engage individuals and families in
their health, establish trust, and influence their decisions at
every stage of care. Accolade connects the widest array of personal
health data and programs to present a single point of contact to
the most effective health and benefits resources, while
coordinating with providers at every step.
The Claims and Benefit Specialist you will work to provide Accolade
Health Assistants (AHAs) accurate and timely resolution to their
clients' problems while coaching AHAs and improving their claims
and coverage knowledge. In addition, you will continuously evaluate
trends, content and processes and make recommendations to fix or
improve them. This job requires deep claims and benefit knowledge,
critical thinking, creative problem solving, the consistent
application of discretion and good judgment, a high degree of
organization, the ability to multi-task, and the ability to develop
strong health plan partner relationships.
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 the Health Assistant Center (HAC).
- Collaborate with Accolade teammates, health plans, and
providers to deliver the best possible service experience for
- Handle claim disputes with partner health plans on behalf of
- 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 claims disputes with partner health plans on
behalf of the client. 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
- 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
- Leveraging your industry knowledge and influencing skills,
encourage future collaboration with health plans and
- 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
What we are looking for---
- A thorough understanding of health care delivery and previous
experience with medical benefits (primarily self-insured plans) and
claims from either provider or payor perspective.
- 3 to 4 years of Health Plan or third party payor claims
processing experience with strong technical skills (business
expertise) and knowledge of various lines of business and
applicable coding (CPT, HCPCS, ICD-9/10, DRG, etc.)
- Health Plan business/benefit analyst with an emphasis on claims
coding (see above line) and benefit set-up
- Health Plan claims quality assurance
- Practice Management or Hospital -Familiar with all bill types
and national account billing
- Engage others by being a good listener with a solid capacity
- Possess excellent communication skills and the ability to
convey passion and enthusiasm.
- Possess superior ingenuity, judgment and problem solving
- Partner/work with teammates to solve issues for clients.
- Organized, dependable and meticulous.
- Flexible with a high tolerance for ambiguity.
- The ability for self-reflection and the capacity to accept and
- Must be computer literate at an intermediate or advanced
- Must display honesty and integrity.
- Must be comfortable working in a telephonic environment with
clients, health plans, and providers.
- COVID 19
VACCINATION & OFFICE POLICY
At this time, Accolade's offices are open to vaccinated employees
only, subject to
limited exceptions, for the safety and wellbeing of our staff.
Most onboarding training is conducted in our offices, but virtual
onboard trainings are occasionally conducted at our discretion.
People & Culture will ask your vaccination status in order to
training classes and protocols, accordingly.
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
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
- All your information will be kept confidential according to EEO
Keywords: Accolade, Inc., Wichita , Claims & Benefits Specialist, Other , Wichita, Kansas
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