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Healthcare Navigator, Claims & Billing

REMOTE

OPERATIONS MEMBER EXPERIENCE

FULL TIME

REMOTE

About Eden Health

Eden Health provides simple, tech-enabled primary care sold directly to employers. Our users enjoy immediate access to care over the Eden Health app, in our private clinics, and directly in their offices. We have transformed healthcare from an unpleasant necessity to a delightful experience focused on improving the lives of patients. The proof is in the outcomes; when companies work with us they have healthier workforces, increased productivity, and reduced healthcare costs.

What you will do

As a Healthcare Navigator, Claims & Billing, you will be responsible for assisting with cost estimates for patients based on insurance company fee schedules, reviewing and following up on all questions regarding bills, Explanation of Benefits, and claims submission requests from our patients. You will be handling these inquiries through our patient facing app, e-mail, and phone. You’ll be expected to complete tasks efficiently and effectively while meeting our SLAs and maintaining high patient satisfaction. You will drive a high-touch patient experience by paying close attention to detail while reviewing their claims and bills for accuracy and resolving any processing or billing issues with insurance companies and third party billing representatives. You will be expected to go above and beyond with every patient interaction and exceed their expectations. You will be working closely with our Healthcare Navigators and Virtual Navigators and report to a Healthcare Navigation Manager. This is a full time, fully remote position with flexibility to work between the hours of 8am-6pm EST Monday – Friday as well as rotational weekend coverage.

What success looks like

• • Efficiently responding to incoming claims and billing inquiries on a day-to-day basis with a commitment to hospitality, patient-centeredness, and excellence
  • Communicating with patients and third parties in adherence with Eden Health’s customer service standards and style guide and using clear, concise, and professional language
  • Engaging with insurance companies and external billing teams to verify that claims were processed accurately (and resolving the errors when they were not)
  • Act as a subject matter expert (SME) related to claims processing troubleshooting and resolution
  • Researching complex benefit and coverage questions, with an ability to simplify difficult concepts for our patients
  • Accurately documenting details of calls and steps taken to complete tasks
  • Providing timely communication and updates to patients
  • Proactively answering patients’ questions and providing information before they ask for it
  • Collaborating with other team members (including Healthcare Navigators, Virtual Navigators, and providers) when assistance or expertise is needed
  • Identifying opportunities for improving our workflows and resources
  • Escalating immediately any cases with any patient dissatisfaction or complaint to relevant team members to ensure the continuous improvement of the patient experience
  • Mentoring and coaching new team members as the team grows
  • Celebrating insurance navigation success stories and learning from patient feedback, thinking about each patient interaction as an opportunity for continuous improvement

What you will bring

• • 2+ years of experience in a Customer Service role
  • 3+ years of experience in a Claims Examiner or related role
  • Ability to work within the hours of 8am-6pm EST as well as rotating weekend shifts
  • Advanced understanding of claims processing procedures, from either a provider or payer perspective
  • Advanced knowledge of complex benefits
  • Experience advocating on behalf of customers
  • An obsession with delivering the highest quality customer experience and going above and beyond for customers
  • An interest in using technology to deliver tech enabled insurance navigation
  • Excellent verbal and written communication skills and strong attention to detail
  • A positive, professional, and empathetic tone with patients
  • The desire to be part of a fast-moving startup
  • Humor, humility and openness to being profusely appreciated as a hero by our patients
  • Ability to adapt to new information quickly
  • Ability to understand healthcare, insurance, and billing jargon. Ability to clearly translate and communicate complex information to our customers
  • Comfortable working independently and being part of a remote, distributed team

Why Eden Health

• • Remote first company and culture
  • Series C Healthtech startup with a mission-driven team that’s passionate about helping every person have a relationship with a trusted healthcare provider
  • Competitive salary and equity compensation package
  • Medical, dental, and vision insurance and commuter benefits
  • Positive, inclusive, supportive culture cheering you on your journey
  • Strong and quickly growing client base of America’s leading employers

The base salary range for this role is $49,600 to $62,000 and is determined based on experience, geography, and qualifications. The base salary is one component of the total compensation package, which includes equity, PTO, and other benefits. This position is salaried, non-exempt with overtime pay eligibility.

While the majority of Eden Health positions are remote-first, we are a company that values building trusted relationships. To achieve this we have programming and events which require us to be in person, including team and company-wide meetings. To ensure everyone’s safety, we require all employees to be fully vaccinated against COVID -19, subject to reasonable accommodations for medical conditions or sincerely held religious beliefs.

Eden Health is an equal opportunity employer and encourages all applicants from every background and life experience without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.