As a Claims Advocacy Specialist, you will play a pivotal role in managing complex member claims escalations, ensuring that issues are resolved efficiently and accurately for our members. You will collaborate cross-functionally with internal teams, such as Member Care Advocacy, Service Quality, and Training, as well as external partners, such as customers and/or insurance companies, to navigate intricate claims escalations and achieve appropriate outcomes. Working closely with Claims Advocacy leadership, you will research operational challenges, identify opportunities for improvement, and contribute to the enhancement of the overall claims experience. The ideal candidate will be curious, quick to learn, and able to work both independently and collaboratively within a team setting. You will be passionate about solving problems, delivering world-class customer service, and driving improvements in healthcare and health outcomes for our members.
This role is an individual contributor and will report into the Manager of Claims Advocacy.

Job Summary:

• Research escalations originating from members, clients and/or client success
• Collaborate ...