Vacancy expired!
Our story This role requires that qualified candidates must reside in one of the following states: Arkansas, Arizona, Alabama, Iowa, Kentucky, Louisiana, Oklahoma, Tennessee, Texas, Nebraska, Montana, Wyoming, New Mexico, Utah , Mississippi, West Virginia, Florida, Kansas, Maine, North Carolina, South Carolina, or Virginia At Alight, we believe a company’s success starts with its people. It’s why we’re so driven to connect passion with purpose. Our team’s expertise in human insights and cloud technology, allows companies and employees around the world to transform and thrive.With a competitive total rewards package, continuing education and training, and tremendous potential with a growing global organization, Alight is the perfect place to put your passion to work.Join our team. Because transformation takes a workforce. Learn more at careers.alight.com .The Health Pro Specialist II position exists as a member of the Health Navigation team to utilize your healthcare benefit knowledge and customer service skills to resolve customer issues. A critical part of your role is to answer inbound calls from our customers to gather the information needed to resolve their needs while demonstrating strong listening skills, empathy and professionalism. You will also be responsible for engaging with healthcare provider offices and insurance carriers to research customer claims issues and insurance benefits questions on behalf of the customer, while ensuring a timely and accurate resolution.#WFH#LI-RemoteResponsibilities:Handle incoming calls to capture customer needs related to:
Claims issues, access to care issues and benefits questions while offering compassion, empathy and strong listening skills to effectively identify the customer’s needs
Document customer need details in case management tool so that it may be researched and resolved
Connecting customers to relevant benefits, resources or programs
Act as a patient advocate to research and resolve complex customer needs or concerns using trained methodologies and tools. The scope of research includes:
delay or denial of treatment
accuracy of claim processing
clarification and education on general or specific benefit plans or programs
prescription access issues
coordinate access to clinical support for education regarding a diagnosis or treatment plan and tracking of referrals
Scheduling customer appointments with healthcare providers
Facilitate obtaining customer’s medical records
Place outbound follow up calls for issues that cannot be resolved during the initial call
Review specific employer plan provisions pertinent to resolving customer questions or concerns
Investigate identified issue by interacting with the health plan, provider, and other third parties as needed
Document all research and summarize calls in the case management system
Participate in ongoing, health care training, ranging from basic health care terminology to claims processing procedures
Maintain understanding of trained topics and processes
Adapt to and implement ongoing training as the company grows and develops in the health care consumerism industry
Qualifications:This role requires that qualified candidates must reside in one of the following states: Arkansas, Arizona, Alabama, Iowa, Kentucky, Louisiana, Oklahoma, Tennessee, Texas, Nebraska, Montana, Wyoming, New Mexico, Utah , Mississippi, West Virginia, Florida, Kansas, Maine, North Carolina, South Carolina, or Virginia
Strong written and verbal communication skills
Excellent customer service and customer resolution skills.
Strong problem-solving skills
Strong organizational and time management proficiencies.
Flexible and adaptable with a demonstrated ability to recognize the need to change priorities to meet the business needs.
Ability to work effectively in a team environment.
Work Conditions:Frequent computer use at a workstation for extended periods of time.
Access information using a computer and related components and peripherals.
Participate in training sessions and meetings.
Ability to be flexible with various shifts and possible overtime when business needs require.
Education:2 years relevant experience in health plan benefitsOR2-year degree (health care benefit related field is preferred)By applying for a position with Alight, you understand that, should you be made an offer, it will be contingent on your undergoing and successfully completing a background check consistent with Alight’s employment policies. Background checks may include some or all the following based on the nature of the position: SSN/SIN validation, education verification, employment verification, and criminal check, search against global sanctions and government watch lists, credit check, and/or drug test. You will be notified during the hiring process which checks are required by the position.Our commitment to Diversity and InclusionAlight believes diversity should be visible, valued, and sustained throughout the organization. And we’re committed to enabling an inclusive culture of belonging that engages all colleagues and grows the diversity of our talent to proudly represent the clients and communities we serve .As an affirmative action employer, we adhere to the principles of equal employment opportunity in the workplace as defined in our diversity policy statement.Diversity Policy StatementAlight does not discriminate against anyone based on sex, gender, race, color, religion, creed, national origin, ancestry, age, physical or mental disability, medical condition, pregnancy, marital or domestic partner status, citizenship, military or veteran status, sexual orientation, gender, gender identity or expression, genetic information, or any other legally protected characteristics or conduct covered by federal, state or local law. In addition, we take affirmative action to employ and advance in employment qualified minorities, women, disabled persons, disabled veterans and other covered veterans.Alight provides reasonable accommodations to the known limitations of otherwise qualified employees and applicants for employment with disabilities and sincerely held religious beliefs, practices and observances, unless doing so would result in undue hardship. Applicants for employment may request a reasonable accommodation/modification by contacting his/her recruiter.Authorization to work in the United StatesApplicants for employment in the United States must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States and with Alight.Note, this job description does not restrict management's right to assign or reassign duties and responsibilities of this job to other entities; including but not limited to subsidiaries, partners, or purchasers of Alight business units.We offer you a competitive total rewards package, continuing education & training, and tremendous potential with a growing worldwide organization..DISCLAIMER:Nothing in this job description restricts management's right to assign or reassign duties and responsibilities of this job to other entities; including but not limited to subsidiaries, partners, or purchasers of Alight business units.Alight Solutions provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, creed, sex, sexual orientation, gender identity, national origin, age, disability, genetic information, pregnancy, childbirth or related medical condition, veteran, marital, parental, citizenship, or domestic partner status, or any other status protected by applicable national, federal, state or local law. Alight Solutions is committed to a diverse workforce and is an affirmative action employer.
