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Claims Advocate
4 months ago
SUMMARY
The Claims Advocate resolves benefit claim issues by managing incoming and outbound calls and emails, collaborating with insurance carriers, providers, and third-party administrators to resolve claim and eligibility concerns for client members. Responds to and educates client members about their health and welfare benefits.
ESSENTIAL FUNCTIONS & RESPONSIBILITES
Supporting Moreton & Company relationships by developing professional and trusting relationships with client members
Assist with member questions and claims issues.
Responding accurately to benefit questions, providing claim resolution expertise and any other assistance and/or support requested or required by the client.
Meeting HIPAA Privacy Rules by maintaining the highest level of confidentiality and complying with all applicable laws.
Advocating and negotiating on behalf of the client members as necessary to assist with eligibility, claim and benefit issues or any question or concern.
Manage assigned clients with minimal supervision from the Department Manager
Establish and maintain effective and positive working relationships with carriers, clients, and fellow co-workers.
Maintain accurate and timely information in agency management systems as outlined by company policy.
Maintain electronic and paper files as outlined by company policy.
Maintain electronic record of communication as outlined by company policy.
Obtain the knowledge and skills to provide back-up to other team members when necessary.
Remain informed of new, updated industry information as well as new product information from the carriers.
Remain informed of State and Federal laws and regulations regarding health and welfare plans.
Become familiar with and follow agency quality control guidelines.
QUALIFICATIONS
- 3-5 years experience and knowledge of health and welfare plan benefits and carriers’ interaction for all lines of coverage (medical, dental, vision, life and AD&D, LTD, STD, Worksite benefits, COBRA, HSA, FSA, HRA)
- degree or industry specific designation preferred
- knowledge of employee benefit concepts and principles.
- to prioritize workload, excellent time management and organizational skills.
- attention to accuracy and details in a fast-paced environment
- able to work independently with little direction.
- negotiating skills, problem solving abilities and math reasoning.
- level of computer literacy and working knowledge of Windows and Office 365
- written, verbal, and presentation skills
PHYSICAL DEMANDS
The employee is occasionally required to stand, walk, and stoop. The employee must regularly lift and/ or move up to 10 pounds. Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions.
