Careers

Our Personal Health Advocates (PHA) are compassionate and dedicated professionals who understand the intricacies of the healthcare system and how to navigate through it. When a member contacts Health Advocate, she or he establishes a relationship with one of our PHAs who stays with the member through to the resolution of their problem. Our PHAs demonstrate a commitment to service excellence, have strong problem solving skills and support members as they seek healthcare services and interact with providers and insurers. Personal Health Advocates work in tandem with Medical Directors and with our team of administrative experts who handle claims, benefits, grievances and paperwork issues.

Job Description - As a Personal Health Advocate, you will:

• Coordinate healthcare related services
• Assist members with coverage and benefits issues
• Negotiate fees with healthcare providers
• Identify and locate physicians, hospitals, wellness services, senior care and behavioral health services
• Represent members during appeals processes as appropriate
• Provide claims assistance by investigating and solving complex claims

Qualifications

• Licensed RN
• Minimum of 3-5 years working in healthcare with a background in case management or utilization management preferred
• Excellent problem-solving skills
• Excellent verbal and written communication skills
• Good time management, organization, research, analytical, negotiation and interpersonal skills
• Proficiency with various software applications (Excel, Word) and familiarity with the web/Internet
• Able to work independently with a minimum of supervision
• High work ethic, results-oriented, and a good, compassionate listener
• Able to work flexible weekdays, including some evenings until 9 PM
• Bilingual in Spanish/English a plus

An Account Manager is needed with proven systems skills and technical experience in prior systems testing or business systems design to install new customers. Responsibilities include interfacing with the sales and operations personnel to obtain appropriate content and to work with the systems personnel on customer programming and/or reporting needs. Successful candidates must have a demonstrated ability to communicate technical concepts strategies and planning terminology understood by business and IT professionals and direct contact experience with corporate clients in a service or project management capacity.
This position reports to the Director of Client Services.

Job Description: As an Account Manager, you will:

1. Serve as the primary contact for the sales team and customers to install clients in a timely manner
2. Produce and distribute installation calendar to ensure timely delivery of installation services
3. Serve as a contact for new clients with questions about installation needs. This includes passwords and access to secure FTP site, file format requirements and loading of eligibility data
4. Accountable for the timely and high quality production of the customer requirements. Performs critical information gathering and interpretation to ensure client specifications regarding products, structure, billing, and eligibility
5. Accountable for tracking the resolution of client issues, following up with other Health Advocate areas to ensure timely resolution
6. Provide support to assigned accounts by responding to inquiries or resolving issues of concern
7. Serve as liaison between the operational units and the sales team to ensure a smooth and complete installation of a client’s account
8. Obtain client specific contractual information and develop it as an accessible reference for operational staff. This includes evaluating current system capabilities and determining best method of data/content storage
9. Enter client data into various core system applications to ensure data integrity and availability to operations staff
10. Documents, tests, implements and provides on-going support for the client’s data and supporting applications
11. Serve as the technical support contact for the reporting database and other systems used by the business enterprise

Qualifications

• Bachelor’s Degree or applicable work experience; incumbents typically have more than 3 years of related experience
• Proven skills on systems and projects/enhancements with at least 3 years of solid, diverse work experience desired
• Ability to perform tasks independent of direct supervision with good follow up
• Excellent organizational skills and time management skills
• Knowledge of insurance products is preferred
• Direct contact with corporate clients in a service or project management capacity
• A technical skill-set including prior systems testing or business systems design experience. Working knowledge of database structures
• Demonstrated ability to communicate technical concepts, strategies and plans in terminology understood by business and IT professionals
• Excellent interpersonal skills - with an emphasis on ability to communicate both verbally and in writing
• Ability to work in a team-based environment required
• Ability to work directly with business partners, clients and vendors required

Our Appeals Specialists are compassionate, dedicated individuals with exceptional problem-solving skills.  They handle complex issues with minimal supervision.  They assist members with health insurance appeals.  They analyze and research denied medical claims and lead efforts to resolve claims issues on behalf of the member.  They process appeals within federally mandated timeframes.  They escalate claims with managerial levels of insurance carriers or group administrators.

Job Description- As an Appeals Specialist, you will:

• Review denial letters, Explanation of Benefits and communications
• Provide guidance and advice to members pursuing health insurance appeals
• Identify contractual appeal timeframes
• Review plan benefit documents such as Summary Plan Descriptions, Certificates of Coverage
• Research validity of denial reasons identified by insurer
• Obtain and review any relevant records and documentation from plan administrator and provider of service
• Ensure documentation is clear and concise for appropriate outcome
• Compassionately communicate with members and provide benefit education to members as needed
• Adhere to all laws and company policy regarding confidentiality of privileged patient information and appeals administration
• Guide, assist or write letters in relation to member appeals
• Assist members preparing for oral appeals hearings

Qualifications

• Bachelor’s Degree
• Compassionate and caring nature with a strong desire to advocate for others
• 3+ years working in health insurance appeals, HR health benefits, health benefits brokerage or other health benefits related environment
• Knowledge of authorization, medical policy and claims payment guidelines in an effort to determine if appeal requires a clinical review or an administrative review.
• Personal computer experience required including a working knowledge of Microsoft Office, Word, Excel, and web based computer applications
• Strong communication and interpersonal skills
• Ability to multi-task in a high volume environment at a fast pace
• Strong analytical, math, communication, verbal and writing skills
• Bilingual in Spanish/English a plus

Our Claims Specialists are compassionate, dedicated individuals with first-rate listening and problem-solving skills who enjoy the challenge of resolving complex billing and claims issues. When a member contacts Health Advocate about a claims issue, the member establishes a relationship with one of our claims specialists who works with the member through to the resolution of their problem.

Job Description- As a Claims Specialist, you will:

• Research and solve claims and billing issues
• Interface with insurance carriers, physicians, hospitals and other healthcare providers
• Help members with eligibility and benefits coverage questions
• Assist in negotiating fees with healthcare providers on behalf of members

Qualifications

• Must have 3 years medical and/or dental billing/claims experience
• Must have experience working with health plan documents, benefit plans
• Must have excellent customer service skills
• Experience with fee negotiation desirable
• Ability to follow-up with health plans, providers and members to resolve questions and problems
• Knowledge of CPT, ICD-9 and HCPCS coding
• Top-notch verbal and written communication skills
• Proficiency with various software applications (Outlook, Excel, Word) and computer systems
• Familiarity with the web/Internet
• Ability to work flexible weekdays, including some evenings until 9 PM
• Bilingual in Spanish/English a plus

A Claims Unit Supervisor is needed to manage an operational unit that allows us to best serve our clients and employees in providing answers regarding employee benefit plans. Responsibilities include managing workflow within a phone and research unit, developing and implementing policies and procedures and training staff to perform specific functions and managing employee performance.

The right candidate will lead recruiting, hiring and training efforts that enable creative solutions to identifying the best candidates and enabling the new hires for success.

Job Description. As a Claims Unit Supervisor, you will:

• Hold responsibility for the administrative functions and supervision of a claims service unit. This includes backlog and quality management for a team of Claims Specialists
• Provide organization, direction and staffing for all assigned service calls and case load assignments to ensure all calls are answered in accordance with Health Advocate’s policies and procedures
• Monitor calls and audit case files daily to ensure the proper target resolution is identified and that, if possible, the case is closed at or near the target resolution
• Ensure assigned staff members meet or exceed the standards, results, and responsibilities of their respective positions
• Coach, mentor, and evaluate the performance of an assigned team
• Assist in the selection, counseling, and discipline of all staff on the team.
• Provide oversight and direction to staff for assigned cases
• Hold responsibility for problem-solving issues and coordinating efforts with internal departments and subject matter experts
• Provide benefit and claims consultation and support when appropriate to all internal departments
• Routinely evaluate and monitor service calls and case management procedures to recommend any necessary changes to the Operations Manager
• Escalate cases through the appropriate channels in accordance with Health Advocate’s policies and procedures

Qualifications

• Claims or Call center experience preferred
• Bachelor's Degree or applicable work experience
• Management or supervisory experience in benefits or claims processing
• Strong leadership skills and the ability to build effective teams
• Effective communication skills to interact with members, physicians, and insurance carrier representatives, with an emphasis on ability to communicate both verbally and in writing
• Assertive, self-confident, and resilient.
• Basic computer skills
• Ability to search and identify resources through the internet.
• Demonstrated ability to communicate concepts, strategies and plans in terminology understood by business professionals.
• Ability to interpret Explanation of Benefits (EOBs).
• Familiarity with various types of health insurance coverage, coordination of benefits, and UCR fees

Our Customer Care Associates are compassionate and dedicated professionals with exceptional listening skills who assist our members in navigating the healthcare system. They work as part of a team and demonstrate customer service excellence.

Job Description- As a Customer Care Associate, you will:

• Assist in locating primary care physicians and dentists
• Thoroughly explain benefit plans to members
• Work as a team member to assist nurses in researching providers, eldercare, nursing homes
• Identify resources and options to assist members
• Concisely and accurately enter documentation into system
• Initial intake/triage of incoming calls- responsible for inputting demographic information into the system and getting the member to the right person

Qualifications

• Excellent verbal and written communication skills required for speaking to members, physicians’ offices, hospitals, insurance companies, healthcare facilities and for noting this in computer system for follow-up
• Attention to detail required for tracking cases and following-up with members and providers on a timely basis
• Must be organized and have ability to multi-task and handle multiple cases
• Team player – willing to learn, assist and help other team members as required
• Must have excellent customer service skills
• A minimum of one year experience in healthcare
• Bilingual in Spanish/English a plus

Health Advocate is seeking customer-oriented professional to work with our client base on member education. The position is based in the Philadelphia area.  Responsibilities include development, implementation, follow-up and evaluation of an education plan for employers, unions, TPAs, brokers/ consultants and other plan sponsors, regionally and nationally.  Travel is required.

Successful candidate must be self-starter with excellent communication skills.  Some professional experience preferred. College degree required. 

If you are submitting your resume via email, kindly type "Education" in the subject line.  If you are sending your resume via mail, please include "Attn:  Member Education" on the envelope.

Full-time administrative assistant is needed for our rapidly expanding sales force.  The successful candidate will enjoy working in a fast-paced sales atmosphere, possess a positive attitude and enjoy working with a highly-motivated sales team.  Must have knowledge of Microsoft Office (Word, Excel, PowerPoint and Access) and experience working with sales personnel.

Health Advocate is seeking proven sales representatives in Denver, Houston, Phoenix, Miami, Ohio, Seattle and St. Louis/Kansas City.  Responsibilities include new business sales to employers, unions, TPAs, brokers/consultants and other plan sponsors, regionally and nationally.
                             
Successful candidates must be self-starters with excellent communication skills and have a proven track record.  Five years successful sales experience working with employee benefits and human resources departments and relationships with decision makers are a plus.  College degree required.  Compensation includes competitive salary, commission and excellent benefits.

If you are submitting your resume via email, kindly type "Sales" in the subject line.  If you are sending your resume via mail, please include "Attn:  Sales" on the envelope.