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Health Pro US Virtual
Job
Alight Solutions
Detroit, MI (In Person)
Full-Time
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Job Description
OurStoryAt Alight, we believe a company's success starts with its people. At our core, we Champion People, help our colleagues Grow with Purpose and true to our name we encourage colleagues to "Be Alight."We are passionate about connectingpurposewith impact.
Alightempowersclientsto builda healthierandmorefinancially secure workforce by unifying the benefits ecosystem across health, wealth, wellbeing,navigation, andabsence management. Our BenefitsWith a comprehensive total rewards package, Alight offers programs and plans that support your mind, body, wallet, and life. Benefits include health, dental and visioncoveragesstartingDay One. Additionally, Alight colleagues enjoy wellbeing programs, retirement plans with contribution matching, generous time off, parental leave, continuing education, and career growth opportunities - all within a thriving global organization. Flexible WorkingSo that you canbeyour best at work and home, we consider flexible working arrangements wherever possible. Alighthas been a leader in the flexible workspace and "Top 100 Company for Remote Jobs"6yearsin a row. Great PlacetoWorkThanks to the work of everycolleague, Alight has received multiple awards of recognition including"GreatPlace to Work" for the past 7 years and Fortune's "Best Companies to Work For." To learn more about our company culture and awardsClick Here. If you,Champion People,seekto Grow with Purpose,and embody the meaning of Be Alight- We invite you to join our team!
Learn more atcareers.alight.com.
When you start, you will receive extensive health care and case management training to ensure you are equipped to support members on complicated healthcare matters. Your primary responsibility is to be an advocate for members requiring guidance across the health benefits environment by helping them navigate questions about their benefits, identify the highest quality and cost-effective providers, understand benefit claims, and be an advocate for the employee across the health ecosystem. You will gather a full understanding of the members' needs and own the resolution of the customer's request. Activities include, but are not limited to the following:
Gathering information about the reason the customer is seeking support or careEducating members on benefit programs provided by clientsTranslating complex benefit details (e.g., deductibles, coverage limits, prior authorizations) into clear, actionable guidance members can understand and useDelivering provider recommendations, referral guidance, and connections to clinical or employersponsored programs to support informed care decisionsCompleting cost estimates and communicating outofpocket responsibility, claim results, denials, appeals, and escalation outcomes with accurate expectations and timelinesExplaining prescription formulary options, prescription alternatives, prior authorization outcomes, and available costsaving opportunitiesProactively identifying unmet clinical needs and owning the connection to appropriate clinical support and care resourcesConnecting members to company sponsored health and benefits programs for specialized careProviding proactive, timely updates via phone and digital channels and ensuring members feel supported through full case resolutionNavigating medical bill review results, including identified errors and savings achieved, and translating findings into clear, actionable guidance for membersDrafting carrier and client appeals for healthcare servicesCoordinating records transfers and authorization requests that require pre-service approval This work involves leveraging developed methodologies, navigating internal tools and applications, as well as making external phone calls, 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 employee cases through resolution. You will interact with members through incoming calls, emails, and messaging system interactions. You will be responsible for utilizing exceptional communication, empathy, and problem solving skills to understand and solve complex customer needs, resulting in a better experience for the employee's entire healthcare journey. Required Qualifications2 years billing/insurance experience, or 3 years' experience in a billing/insurance/benefits related roleAbility to work effectively in a remote team environmentStrong problem solving, critical thinking, and analytical skills - ability to comprehend a member's needs and determine the steps required to complete their requestExceptional written communication skills - can convey complex concepts in writing for members that are not benefits expertsStrong ability and desire to learn continually in a changing environmentAbility to efficiently organize work activities to meet deadlinesPassion to provide the highest level of client satisfactionAbility to receive and immediately apply constructive feedbackProficiency in MS Office suite Preferred QualificationsPrevious healthcare setting... For full info follow application link. 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
Alightempowersclientsto builda healthierandmorefinancially secure workforce by unifying the benefits ecosystem across health, wealth, wellbeing,navigation, andabsence management. Our BenefitsWith a comprehensive total rewards package, Alight offers programs and plans that support your mind, body, wallet, and life. Benefits include health, dental and visioncoveragesstartingDay One. Additionally, Alight colleagues enjoy wellbeing programs, retirement plans with contribution matching, generous time off, parental leave, continuing education, and career growth opportunities - all within a thriving global organization. Flexible WorkingSo that you canbeyour best at work and home, we consider flexible working arrangements wherever possible. Alighthas been a leader in the flexible workspace and "Top 100 Company for Remote Jobs"6yearsin a row. Great PlacetoWorkThanks to the work of everycolleague, Alight has received multiple awards of recognition including"GreatPlace to Work" for the past 7 years and Fortune's "Best Companies to Work For." To learn more about our company culture and awardsClick Here. If you,Champion People,seekto Grow with Purpose,and embody the meaning of Be Alight- We invite you to join our team!
Learn more atcareers.alight.com.
Career Development & Growth:
We provide ongoing training, coaching and development specific to the Navigation Research role and reward continuous improvement, while encouraging you to own your own development. As a Health Pro, you can expect the following:When you start, you will receive extensive health care and case management training to ensure you are equipped to support members on complicated healthcare matters. Your primary responsibility is to be an advocate for members requiring guidance across the health benefits environment by helping them navigate questions about their benefits, identify the highest quality and cost-effective providers, understand benefit claims, and be an advocate for the employee across the health ecosystem. You will gather a full understanding of the members' needs and own the resolution of the customer's request. Activities include, but are not limited to the following:
Gathering information about the reason the customer is seeking support or careEducating members on benefit programs provided by clientsTranslating complex benefit details (e.g., deductibles, coverage limits, prior authorizations) into clear, actionable guidance members can understand and useDelivering provider recommendations, referral guidance, and connections to clinical or employersponsored programs to support informed care decisionsCompleting cost estimates and communicating outofpocket responsibility, claim results, denials, appeals, and escalation outcomes with accurate expectations and timelinesExplaining prescription formulary options, prescription alternatives, prior authorization outcomes, and available costsaving opportunitiesProactively identifying unmet clinical needs and owning the connection to appropriate clinical support and care resourcesConnecting members to company sponsored health and benefits programs for specialized careProviding proactive, timely updates via phone and digital channels and ensuring members feel supported through full case resolutionNavigating medical bill review results, including identified errors and savings achieved, and translating findings into clear, actionable guidance for membersDrafting carrier and client appeals for healthcare servicesCoordinating records transfers and authorization requests that require pre-service approval This work involves leveraging developed methodologies, navigating internal tools and applications, as well as making external phone calls, 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 employee cases through resolution. You will interact with members through incoming calls, emails, and messaging system interactions. You will be responsible for utilizing exceptional communication, empathy, and problem solving skills to understand and solve complex customer needs, resulting in a better experience for the employee's entire healthcare journey. Required Qualifications2 years billing/insurance experience, or 3 years' experience in a billing/insurance/benefits related roleAbility to work effectively in a remote team environmentStrong problem solving, critical thinking, and analytical skills - ability to comprehend a member's needs and determine the steps required to complete their requestExceptional written communication skills - can convey complex concepts in writing for members that are not benefits expertsStrong ability and desire to learn continually in a changing environmentAbility to efficiently organize work activities to meet deadlinesPassion to provide the highest level of client satisfactionAbility to receive and immediately apply constructive feedbackProficiency in MS Office suite Preferred QualificationsPrevious healthcare setting... For full info follow application link. 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