Health Pro Specialist II at Alight Solutions in Dallas, Texas

Job Description:

Alight unlocks enterprise growth for the world's most influential companies with future ready human capital and business solutions. We combine industry leading data and insights with unmatched depth and operational expertise to improve the employee experience and optimize cloud-enabled business processes. Our 15,000 colleagues proudly serve thousands of clients and their more than 30 million employees and family members throughout 180 countries. Learn how Alight helps organizations of all sizes, including over 70% of the Fortune 100, achieve next level transformation at alight.com.

This position exists as a member of the Health Navigation team to provide front-lines customer service support to customers, as they seek to understand their medical, dental, and vision benefits, anticipate cost, leverage high quality, in-network providers, and navigate the nuances of their revolutionary health insurance plan. In addition to being uniquely positioned as the primary resource for understanding and using their healthcare benefits, this customer service team is also on point to help customers navigate invoicing and claims processing.

The role primarily involves answering inbound calls from our customers to gather the information needed to resolve their needs - providing same-call resolution whenever possible. However, for customer requests that cannot be resolved over the phone, team members will also be responsible for engaging with healthcare provider offices and insurance carriers to research claims issues and insurance benefits questions on behalf of the customer

We're looking for candidates with exceptional customer service, professionalism - and a passion for simplifying the healthcare experience one customer interaction at a time.

Responsibilities:

Handle incoming calls to capture and action customer needs related to:

• Claims issues, access to care issues and benefits questions


• Cost transparency and provider steerage


• Coordination of benefits


• Invoicing, premiums, and claims processing

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


• 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


• Trouble-shooting financial assistance offerings and requests for technical support


• Reviewing eligibility criteria to determine feasibility for coverage adjustments

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

Relay research findings to Health Pro Consultant to review and communicate to customer

Qualifications:

• Strong written and verbal communication skills


• Excellent customer service and customer resolution skills.


• Strong problem-solving skills


• Ability to learn quickly


• Strong organizational and time management skills


• Flexible and adaptable with a demonstrated ability to reorganize priorities as business needs change


• Ability to work effectively in a team environment.


• Technology proficient

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 benefits

OR

2-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 of 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, fingerprint verification, credit check, and/or drug test. You will be notified during the hiring process which checks are required by the position.

At Alight, we believe that diversity should be visible, valued, and sustained throughout the organization. Alight provides equal treatment and employment opportunities to all employees and applicants for employment without regard to any protected status or other protected characteristic.

Alight does not discriminate against anyone based on sex, 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, sincerely held religious beliefs, practices and observances, unless doing so would result in an undue hardship. Applicants for employment may request a reasonable accommodation/modification by contacting his/her recruiter.

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.
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