Offer summary

Qualifications:

High school diploma or GED required; 2-year associate's degree in healthcare or health sciences preferred., Experience in healthcare, particularly in research and resolving benefits and claims, is essential., Previous roles such as Health Guide, Claims Specialist, or Medical Assistant are advantageous., Strong communication skills and proficiency in office tools like Microsoft are necessary..

Key responsabilities:

Provide research and support for Family Health Advocates in resolving cases.

Coordinate issue resolution with providers, payers, and third parties.

Manage assigned tasks requiring research and resolution in a timely manner.

Assist with community resource searches and ordering durable medical equipment.

Job description

Job Description:

Job Summary:

The role of the Family Health Advocate-Research Analyst is an exciting and integral role in providing meaningful advocacy support to members and their families through personalized resource and referral facilitation, issue resolution and healthcare navigation. In this role you will provide research to support and resolve cases originating from our Family Health Advocates that require additional follow up. Case follow-ups include but are not limited to the coordination of benefits, health claim appeals, re-submissions and/or re-coding, EOB reviews and researching provider availability and scheduling appointments.

Essential Job Functions:

Support follow up needs from Family Health Advocate calls for the following:

Research and resolution to eligibility, claims issues, ID card issues, grievances/appeals, utilization management (UM) status including but not limited to medical, dental, and vision plans

Provider search (PCP, specialty, and facility), focused on healthcare cost and quality, and present premier provider options, including but not limited to medical, dental, and vision plans

Support for spending accounts, pharmacy, and disability.

Aid with ordering durable medical equipment (DME)

Community resource search

Coordinate issue resolution with providers, payers or 3rd parties for:

Claims adjustments

Grievances and appeals submissions

Utilization management intake or status

Complex pharmacy inquiries

Complex spending account inquiries

Appointment availability

Primary duties include but are not limited to:

Research and documentation of issue resolutions.

Timely management of assigned queue tasks requiring research and resolution

Work closely with assigned Family Health Advocates to ensure timely resolution and follow up of tasks

Specific Skills/ Attributes:

Excellent multi-channel communication and problem-solving skills

Ability to communicate effectively in both voice and chat channels, including critical thinking skills, effective typing, grammar, and spelling skills.

Proficient in general office tool use and navigation (i.e., Microsoft)

Qualifications:

High school / GED diploma

2-yr associates degree in healthcare/health sciences OR equivalent experience in healthcare, preferably with research and resolving benefits and claims, OR held one or more of the following positions:

Health Guide/Advocate/Navigator

Claims Specialist/Processor

Medical Assistant

Medical Secretary/Clinic Manager

Medical Coder

Customer service experience within a healthcare contact center, provider office, or healthcare institution

Experience in successful resolution of high level/sensitive customer service issues.

Sharecare and its subsidiaries are Equal Opportunity Employers and E-Verify users. Qualified applicants will receive consideration for employment without regard to race, color, sex, national origin, sexual orientation, gender identity, religion, age, equal pay, disability, genetic information, protected veteran status, or other status protected under applicable law.

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