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Claims Escalation Specialist

Sidecar Health

Sidecar Health

Remote
Posted on Wednesday, January 10, 2024

Sidecar Health is redefining health insurance. Our mission is to make excellent healthcare affordable and attainable for everyone. We know that to accomplish this lofty mission, we need driven people who will make things happen.

The passionate people who make up Sidecar Health’s team come from all over, with backgrounds as tech leaders, policy makers, healthcare professionals, and beyond. And they all have one thing in common—the desire to fix a broken system and make it more personalized, affordable, and transparent.

If you want to use your talents to transform healthcare in the United States, come join us!

*Must reside in OH, IA, MN, NC, WI, GA, or FL for consideration*

About the Role

As an Escalations Analyst, you'll handle inquiries from Account Managers regarding member issues, researching and analyzing escalation tickets to provide timely and informed responses. Your expertise in claims processes and policy will be crucial in delivering comprehensive data and communication to satisfy our members' health insurance needs.

What You'll Do
  • Collaborate with Account Managers in resolving escalations tickets for group fully insured health plan members
  • Perform root cause analysis for escalated member issues, including claims outcomes, deductible issues and other account questions
  • Summarize findings clearly and concisely so that Account Managers can effectively communicate information to members/group representatives
  • Recommend solutions as needed and initiate necessary actions (claim adjustment, pricing issues, technical difficulties) with relevant departments for streamlined resolution
  • Understand and effectively communicate a wide breadth of claims issues including deductibles, credit transfers, preventive care, benefits, specialty, etc
  • Serve as a liaison between Clinical, Legal, Engineering, Actuary, Coding, and Business teams to facilitate discussions, present solutions, and reach consensus on claims decisions
  • Review claims reconsideration requests and process claim adjustments in the claims platform
What You'll Bring
  • 2+ years of experience with facility and professional billing, including familiarity with CPT codes, ICD-10 codes, and DRG codes
  • Strong problem-solving skills and the ability to thrive in a dynamic startup environment
  • Excellent communication, organization, and relationship building skills
  • Strong work ethic and willingness to go above and beyond to resolve member issues
  • Passionate about finding solutions to problems
  • Clear sense of ownership, bias for action, and superior problem-solving and communication skills
  • Healthcare or health insurance experience (Preferred)
  • Bachelor's degree (Preferred)

What You'll Get

  • Competitive hourly rate, company equity, and ample opportunities for growth
  • Comprehensive Medical, Dental, and Vision benefits with no waiting period
  • Paid vacation and company holidays
  • IT Equipment, including laptop and monitors
  • An opportunity to make an impact at a rapidly growing mission-driven company transforming healthcare in the U.S.

Sidecar Health is an Equal Opportunity employer committed to building a diverse team. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status or disability status.