Claims Advocate - Employee Benefits

Description

WHO WE ARE

Relation Insurance is a leading, innovative company with a strong commitment to excellence and a passion for delivering cutting-edge solutions to our clients. As a key player in the insurance market, we pride ourselves on our dynamic culture, collaborative environment, and continuous drive for success. With a rich history and a bright future ahead, we are looking for exceptional individuals to join our team and contribute to our ongoing growth and success.

WHAT WE'RE LOOKING FOR

The primary responsibility of the Lead Claims Advocate is to resolve claims or benefit issues.  This position works independently to address issues, interpret carrier payment documents and resolves grievances. This is achieved by answering incoming calls from providers and insureds regarding clarification of benefits, status of claims, status of eligibility, and any other inquiry received.

A GLIMPSE INTO YOUR DAY

• Independently manages service for the entire department.
• Answers all customer inquiries via phone and email using company guidelines and the utmost professionalism.
• Provides status of claims and eligibility and benefit information to insureds/providers as permitted by the company.
• Verifies provider network information.
• Independently researches problem cases and provides resolution.
• Answers and provides resolution to all other inquiries from customers.
• Works with Claims Examiners to manage specific claims inquiries per company guidelines.
• Assists Auditor, Leads, and/or Examiners with any routine assignments or special projects.
• Performs other duties and special projects as assigned.

Requirements

WHAT SUCCESS LOOKS LIKE IN THIS ROLE

• State Life, Accident & Health Insurance License is required and must be maintained.
• High School Diploma or equivalent, bachelor’s degree preferred.
• Minimum 3 years of experience in benefits industry.
• Thorough knowledge of benefit plans offered through carriers.
• Outstanding interpersonal and communications skills are required to maintain effective relationships with clients, co-workers, carriers, vendors and others.
• Excellent written and oral communication skills.
• Proficient computer skill, including advanced knowledge of Excel.
• Working knowledge of the laws and regulations associated with HIPAA.
• Strong understanding of claims adjudication process.
• Ability to work independently and on a team.

WHY CHOOSE RELATION?

• Competitive pay.
• A safe and healthy work environment provided by our robust benefit program including family health and wellness programs, 401K, employee assistance programs, paid time off, paid holidays and more.  
• Career advancement and development opportunities.
• Paid training and continuing education to obtain/maintain your insurance license.

Note: The above is not all encompassing of the full position description. 

Relation Insurance Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.  

The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Relation, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is presented within this posting. 

You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance.