Member Advocate – Claims Analyst

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Calling all problem-solvers! Westaff is on the hunt for a Member Advocate – Claims Analyst for an insurance company in Helena, MT!

Schedule: Full-time

Shift: 8am – 5pm, M-F

Term: 3+ months

Pay: $25/hour

Duties:

Identify and implement opportunities to improve member experience
Thoroughly research and resolve escalated member service issues, including benefit inquiries, ID card issues, enrollment issues, and claims issues
Analyze customer inquiries and determine correct steps for resolution, interpret benefit information, and claims processing
Analyze claims processing. Interpret claims edits, benefit configuration, procedure, and diagnostic codes, strategize and navigate correction and resolution
Support member retention through management of delegated entities responsible for customer service
Support navigation of escalated complaints, identify root cause, and implement solutions
Answering member service calls, emails and responding to walk-ins
Processes walk-in member payments in the enrollment and billing system promptly when needed
Assists members with accessing and navigating the Member Portal.
Conducts quality reviews of public-facing materials to ensure accuracy and professionalism
Develop training materials and deploy training for MHC staff
Create policies and procedures
Prepare and review member materials used to communicate policy information
Test member information for accuracy and timeliness
Participate in team setting with multiple functional areas to assure seamless customer service

Qualifications:

Three years of health plan experience in customer service or claims role required
Certified Professional Coder (CPC) or Certified Professional Coder Apprentice (CPC-A) strongly preferred
Two years of experience with computer applications, expert level experience in Word and Excel preferred
Broad understanding of healthcare systems, such as claims, benefits, networks, utilization management, and appeals
Innovative problem solving starting with root cause analysis
Ability to work independently without direct supervision
Outstanding oral and written communication skills, with the ability to communicate ideas to multiple functional teams and executive managers
Strong analytical and report writing skills
Demonstrated adaptability and flexibility to new ideas, methodologies, and creative alternatives
Strong organizational/project management skills
Ability to juggle multiple projects
Ability to collaborate with various teams, internally and externally
Computer application proficiency

Successful applicant(s) will be subject to a background check.

Military & Veterans encouraged to apply

Ready to level up your career? Apply today!

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