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Claims & Benefits Specialist

Claims & Benefits Specialist

Job Location 
US-PA-Plymouth Meeting
Posted Date 

More information about this job

Role Overview

As an AccoladeHealth Assistant, you will be a trusted advisor who helps employees and their families with any issue related to healthcare from getting the right care when they need it to understanding how to get the most from their health care benefits. As a specialist in claims and benefits you will work to provide your colleagues accurate and timely solutions to their clients’ problems while coaching and developing AHAs and improving our claims and coverage content and processes. This job requires critical thinking, creative problem solving and the consistent application of discretion and good judgment, as well as a high degree of organization.

A Day in the Life


  1. Be a great Accolade Health Assistant, and in particular a role model for other AHAs in resolving claims and benefits issues for and with clients.

  2. Act as trusted source of complex claims and benefit questions for internal customers

  3. Act as liaison to health plans and providers to solve complex claims and coverage issues and get claims

    processing/payment issues corrected.

  4. Educate AHAs in helping them better understand claims and benefit question resolution, both in helping with specific

    client issues and in new hire and ongoing training.

  5. Identify opportunities to improve how we resolve claims and benefit issues, including improvements to MRM, workboxes,

    our benefits, and other tools and resources.

  6. Collaborate with Accolade team mates to deliver best possible service experience for Accolade clients.

  7. Collaborate with health plans and providers to deliver best possible service experience for our clients and encourage

    future collaboration with health plans and providers.


  1. Support AHAs with eligibility, benefits, and claims questions and/or issue resolution, including understanding the root cause of the issue Handle claims disputes with partner health plans on behalf of the client.Handle claim disputes with partner health plans on behalf of the client
    • Listen, assess, and comprehend the clients’ presenting issue(s) and use critical thinking, judgment, and problem solving to take appropriate action.
    • Provide colleagues with timely and accurate solutions to their client’s complex claims problems.
    • Evaluate clients’ claims and care needs and make recommendations to AHAs as to other opportunities or resources to support the clients’ needs.
  2. Handle claim disputes with partner health plans on behalf of the client
    • Ensure compliance with internal and external health plan partner business processes.
    • Develop and maintain solid working relationships and processes with health plans and other payors.
  1. Effectively manage an ongoing portfolio of claims/benefits issues, ensuring timely, complete and accurate resolution in support of client expectations and health plan processing guidelines.

  2. Participate in special projects as requested
  3. Able to do all of the above in a collaborative, open-office, telephonic, technology enabled environment


Desired Qualifications and Experience
A thorough understanding of health care delivery and previous experience with medical benefits (primarily self-insured plans) and claims from either provider or payor perspective.


Examples of prior job experience/expertise:

  • Health Plan or third party payor claims processing experience with strong technical skills (business expertise) and knowledge of various lines of business and applicable coding (CPT, HCPCS, ICD-9/10, DRG, etc.)

  • Health Plan business/benefit analyst with an emphasis on claims coding (see above line) and benefit set-up

  • Health Plan claims quality assurance

  • Practice Management or Hospital Familiar with all bill types and national account billing


Desired Personal Characteristics
  • Engage others by being a good listener with a solid capacity for empathy.

  • Possess excellent communication skills and the ability to convey passion and enthusiasm.

  • Possess superior ingenuity, judgment and problem solving skills.

  • Partner/work with teammates to solve issues for clients.

  • Organized, dependable and meticulous.

  • Flexible with a high tolerance for ambiguity.

  • The ability for self-reflection and the capacity to accept and implement feedback.

  • Must be computer literate at an intermediate or advanced level.

  • Must display honesty and integrity.

  • Must be comfortable working in a telephonic environment with clients, health plans, and providers.

Who we Are

Accolade offers the country’s leading consumer healthcare engagement and influence solution for large self-insured employers and payer organizations. Our single, integrated solution combines the power of technology with 1:1 human interactions to help people get the right care and have a better healthcare experience.
By addressing some of the biggest problems facing healthcare
system complexity, low consumer engagement and lack of trust – we’re able to reduce avoidable consumer errors and the estimated 30-40% of waste in the system caused by unnecessary or unproductive care.

The way we make healthcare simpler and less costly is to give individuals and families access to their own professional Accolade Health Assistant®. Our health assistants are a single point of contact for any health benefit or healthcare-related need. By taking the time to get to know their clients as individuals and understanding the contextual issues surrounding their decisions, health assistants are able to develop trust-based relationships, which lead to greater influence over care decisions, better health outcomes and greater savings. At the same time, we’re delighting the families we serve, earning world-class Net Promoter Scores and near-perfect client satisfaction ratings.


Founded in 2007 and headquartered in Plymouth Meeting, Pa., Accolade has nearly 600 employees serving the individuals and families of some of the nation’s largest businesses. We’ve been recognized as one of the nation’s 25 most promising companies by Forbes magazine, the fastest-growing private healthcare company by Inc. 500, and a Top Workplace in Philadelphia for five consecutive years. For more information, visit

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