As a Claims Advocacy Specialist, you will help manage complex member claims escalations, ensuring that issues are resolved for our members. You will collaborate with other teams, such as Member Care Advocacy, Service Quality, and Training, and external partners, such as customers and insurance companies, to navigate intricate claims escalations and achieve appropriate outcomes. Working with Claims Advocacy leadership, you will research operational challenges, identify opportunities for improvement, and contribute to the enhancement of the overall claims experience. You are curious, quick to learn, and collaborative within a team setting. You will be passionate about solving problems, delivering world-class customer service, and driving improvements in healthcare and health outcomes for our members.
You will be an individual contributor and will report into the Manager of Claims Advocacy.Job Summary:Research escalations originating from members, clients and client successCollaborate with internal (e.g. Quality) and external partners (e.g. carriers) to ensure claims escalations are resolved and responded-to within defined turn-around-timesCreate action plans to address widespread issues raised by member feedbackGuide improvements through developing strategic contacts and internal collaborationHelp with process-development with external vendors and carriersDraft Job Aids to support new programsManage SOPs to reflect most current directivesMentor team members for performance improvementsTrain new hires and support onboarding processProvide team support for complex scenarios and finding resolutionsCollate member impact stories for newsletter, marketing and team impactSupport team morale through difficult cases and adversityRequired Qualifications:2+ years experience in claims processing or revenue cycle managementMastery of de-escalation techniques and customer serviceIdentify issues at scaleDemonstrate high levels of empathyCurious nature- wanting to dig in and understand causes of problemExperience working cross-functionallyPhysical/Cognitive Requirements:Prompt and regular attendance at assigned work location.Ability to remain seated in a stationary position for prolonged periods.Requires eye-hand coordination and manual dexterity sufficient to operate keyboard, computer and other office-related equipment.No heavy lifting is expected, though occasional exertion of about 20 lbs. of force (e.g., lifting a computer / laptop) may be required.Work with leadership, employees, and members in an appropriate manner.The United States new hire base salary target ranges for this full-time position are:
Zone A: $66,850 - $86,910 + equity + benefitsZone B: $73,535 - $95,601 + equity + benefitsZone C: $80,220 - $104,292 + equity + benefitsZone D: $86,905 - $112,983 + equity + benefits
This range reflects the minimum and maximum target for new hire salaries for candidates based on their respective Zone. Below is additional information on Included Health's commitment to maintaining transparent and equitable compensation practices across our distinct geographic zones.
Starting base salary for you will depend on several job-related factors, unique to each candidate, which may include education; training; skills; years and depth of experience; certifications and licensure; our needs; internal peer equity; organizational considerations; and understanding of geographic and market data. Compensation structures and ranges are tailored to each zone's unique market conditions to ensure that all employees receive fair and great compensation package based on their roles and locations. Your Recruiter can share details of your geographic alignment upon inquiry.
In addition to receiving a great compensation package, the compensation package may include, depending on the role, the following:
Remote-first culture401(k) savings plan through FidelityComprehensive medical, vision, and dental coverage through multiple medical plan options (including disability insurance)Full suite of Included Health telemedicine (e.g. behavioral health, urgent care, etc.) and health care navigation products and services offered at no cost for employees and dependentsPaid Time Off ("PTO") and Discretionary Time Off ("DTO")12 weeks of 100% Paid Parental leaveFamily Building Benefit with fertility coverage and up to $25,000 for Surrogacy & Adoption financial assistanceCompassionate Leave (paid leave for employees who experience a failed pregnancy, surrogacy, adoption or fertility treatment)11 Holidays Paid with one Floating Paid HolidayWork-From-Home reimbursement to support team collaboration and effective home office work24 hours of Paid Volunteer Time Off ("VTO") Per Year to Volunteer with Charitable OrganizationsYour recruiter will share more about the specific salary range and benefits package for your role during the hiring process.#LI-Remote
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 .
-----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.