Claims Analyst - Virtual

Our Story

At Alight, we believe a company’s success starts with its people. Alight embraces values that come directly from our people – purposeful, human, united and growth-minded – reflecting our inclusive culture and promise that our clients expect. We are passionate about connecting purpose with impact. Alight empowers clients to build a healthier and more financially secure workforce by unifying the benefits ecosystem across health, wealth, wellbeing, navigation, and absence management.

With a comprehensive total rewards package, Alight offers programs and plans that support your mind, body, wallet, and life. Benefits include health, dental and vision coverages starting Day One. Additionally, Alight colleagues enjoy wellbeing programs, retirement plans with contribution matching, generous time off, parental leave, continuing education & training, and career growth opportunities – all within a thriving global organization.

So that you can be your best at work and home, we consider flexible working arrangements wherever possible. Alight has been a leader in the flexible workspace and “Top 100 Company for Remote Jobs” 6 years in a row.

Thanks to the work of every colleague, Alight has received multiple awards of recognition including “Great Place to Work” for the past 7 years and Fortune’s “Best Companies to Work For.”

A competitive total rewards package, continuing education & training, and tremendous potential with a growing worldwide organization:

• A full Benefits Package, starting on your first day of employment
• Health, Dental, Vision, Life Insurance and more.
• A 401k plan that includes a corporate match.
• Paid Time Off

We provide ongoing training, coaching and development. We reward continuous improvement and encourage you to own your own development. Take advantage of some of the best training and tools in the world to learn more about multiple areas of Human Resources!

Alight provides a collaborative environment that embodies and holds the following stated values close to heart:
Champion people, Grow with purpose, and Be Alight.

• When you start, you will receive extensive health care training to ensure you are equipped to consult members on billing related issues
• Your primary responsibility is to be an advocate for members by working on their behalf with carriers, providers, and plan related documentation to resolve post-service coverage questions and/or issues in an accurate and timely manner. Activities include, but are not limited to the following:
  • Assist in reviewing medical, dental, vision, and pharmacy related claims for accuracy to ensure members are receiving the proper benefit coverage according to plan stipulations
  • Coordinate with providers and carriers to solve billing discrepancies, coding errors, and denied claims; assist with claim resubmission, as necessary
  • Draft, submit, and exhaust appeals processes, as necessary
  • Partner directly with client to bring awareness to unique care/billing situations that may require special review
  • Coordinate with providers to determine payment plan and discount options

This work involves leveraging developed methodologies, navigating internal tools, and applications, as well as making external phone calls, and partnering with carriers and providers (via email and phone outreach) to resolve member needs. The scope of work is dedicated at the employee level and you will be responsible for working cases through resolution.

• Bachelor’s Degree, Associate’s Degree with 2 years billing/insurance experience, or 3 years’ experience in a healthcare billing/insurance related role
• Ability to work effectively…