Claims Support Advocate Full Time NEW

As a Claims Support Advocate (CSA), you will be part of a vibrant team of high performing and highly engaged professionals that work to ensure a quality member experience within our service level agreements. The CSA serves as a liaison between plan members, providers and health insurance companies to resolve member claim inquiries. The CSA handles all communication, paperwork, and negotiations with a health insurance carrier or provider on the behalf of the plan member.

Responsibilities

• Your primary objective is to provide effective and timely customer service for members, providers, insurers and clients regarding health care claims
• Ensure timely follow-up on requests for accounts to be reviewed
• Organize health insurance paperwork and medical record documentation
• Demonstrate knowledge of proprietary software and other required technology (Google apps, Slack, etc)
• Communicate timely status updates to patients throughout the claims process
• Negotiate with providers on plan member balances
• Appeal claim denials from the insurance company
• Contact providers and insurance companies to resolve claim concerns
• Assist with understanding of explanation of benefits (EOBs)
• Assisting members with resolving claim errors or denials. Ideally to recoup or lower their medical expenses
• Collaborate with peers and management across functions
• Understand the evolving business requirements and adapt the operational processes to meet those requirements
• Speak clearly, confidently and maintain professionalism as well as friendly member interactions while demonstrating persuasion in overcoming objections
• Ability to handle a fast-paced, dynamic environment with competing priorities
• Model a culture reflective of our core company values
• Gain and retain a thorough understanding of the team and company policies, processes, software, etc
• Including other duties and responsibilities as assigned by leadership

Required Qualifications

• 1 year experience in customer service roles
• 3 years of revenue cycle or carrier experience
• Passion for providing support
• Prior work experience in a claims support and health insurance role
• Ability to take meticulous notes and document actions taken
• Highly effective communication, problem resolution and organizational skills
• Demonstrated ability to meet goals in a rapidly changing environment
• Excellent data and overall analytical skills
• Excellent written and verbal communication skills
• Proven record of excellent time management and prioritization skills
• Ability to troubleshoot basic technical issues
• Proven track record of driving measurable efficiency results.

Preferred Qualifications

• College degree preferred (additional experience in lieu of college degree will be considered)
• Medical billing/coding certification (CPC) is beneficial, but not required

Physical/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.
• Ability to interact 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: $22.84 – $29.69

Zone B: $25.13 – $32.66

Zone C: $27.41 – $35.63

Zone D: $29.69 – $38.60

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 the successful candidate will depend on several job-related factors, unique to each candidate, which may include, but not limited to, education; training; skill set; years and depth of experience; certifications and licensure; business needs; internal peer equity; organizational considerations; and alignment with 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 competitive compensation based on their roles and locations. Your Recruiter can share details of your geographic alignment upon inquiry.

Role

This position is a temp-to-hire role, if converted to a FTE, in addition to receiving a competitive base salary, the compensation package may include, depending on the role, the following:

• Remote-first culture
• 401(k) savings plan through Fidelity
• Comprehensive 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 dependents
• Generous Paid Time Off (“PTO”) and Discretionary Time Off (“DTO”)
• 12 weeks of 100% Paid Parental leave
• Family Building Benefit with fertility coverage and up to $25,000 for Surrogacy & Adoption financial assistance
• Compassionate Leave (paid leave for employees who experience a failed pregnancy, surrogacy, adoption or fertility treatment)
• 11 Holidays Paid with one Floating Paid Holiday
• Work-From-Home reimbursement to support team collaboration and effective home office work
• 24 hours of Paid Volunteer Time Off (“VTO”) Per Year to Volunteer with Charitable Organizations

Your recruiter will share more about the specific salary range and benefits package for your role during the hiring process.

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 includedhealth.com.

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 with arrest or conviction records in accordance with the San Francisco Fair Chance Ordinance, the Los Angeles County Fair Chance Ordinance, and California law.

Included Health uses AI-assisted tools at select stages of the hiring process to enhance efficiency, consistency, and communication. AI does not make hiring decisions—final decisions are made exclusively by our recruiting and hiring teams.