Claims and Benefits Specialist

Working hours: 13.30-22.00 (Mon-Fri)

Start date: 1st July 2025

Contract limited to 1 year (possibility to extend)

Transcarent and Accolade have come together to create the One Place for Health and Care, the leading personalized health and care experience that delivers unmatched choice, quality, and outcomes. Transcarent’s AI-powered WayFinding, comprehensive Care Experiences – Cancer Care, Surgery Care, Weight – and Pharmacy Benefits offerings combined with Accolade’s health advocacy, expert medical opinion, and primary care, allows us to meet people wherever they are on their health and care journey. Together, more than 20 million people have access to the combined company’s offerings. Employers, health plans, and leading point solutions rely on us to provide trusted information, increase access, and deliver care

You will be a part of a large team of open-minded professionals with diverse backgrounds and experience. You will join a dynamic work environment and have colleagues from all over the world. In your role, Claims & Benefits Specialist are primarily solving inbound tasks and instant messages from our internal team and resolve complex cases regarding claim, benefit, and eligibility issues by using internal tools, health plan insurance systems, and coordinating with our health plan partners.

A day in the life… 

• Act as a trusted partner for complex claims and benefit questions and issue resolutions. 

• Liaise with our Health Plan partners via phone call several times per day to investigate and resolve member issues. 

• Handle claim disputes with partner Health Plans on behalf of the member. 

• Provide colleagues with timely and accurate solutions to our member’s complex claims problems, in line with the department’s TAT expectations. 

• Meet KPI expectations by completing 15-20 tasks per day. 

• Educate our internal teams by helping them better understand claims and benefit questions/issue resolution and support ongoing training/learning with frontline employees. 

• Collaborate with teammates, member services teams, and Health Plans to deliver the best possible service experience for members. 

• 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. 

• Support internal teams with eligibility, benefits, and claims questions and/or issue resolution, including understanding the root cause of the issue. 

• Identify opportunities to improve how we resolve claims and benefit issues, including improvements to our internal systems, our benefit content, and other tools and resources. 

• Participate in special projects as requested. 

• Cross-coverage between departments with transferable skill sets 

• Ad-hoc tasks based on the business needs. 

To be successful in this role, it is expected that you have: 

• Excellent knowledge of English language, strong communication skills both in written and verbal 

• Ability to work independently, organize, and prioritize own tasks effectively. 

• Previous experience in roles where technology, multi-tasking and verbal/written communication is used to drive their day-to-day responsibilities is an advantage. 

• High level of confidence working across several different systems on a daily basis. 

While working at Accolade you will enjoy the following benefits:

• 5 weeks of vacation + personal days

• 1 paid day off for your volunteerism per year

• Sodexo Gastro Pass Card with no contribution

• Flexi Pass Card per month or Multisport Card

• FreshPoint fridge with meals & snacks at a 30% discount

• Yoga classes with a contribution

• Work from abroad for up to 4 weeks a year

• Udemy Business Platform for Hard/Soft skills training

• Virtual hospital service uLekare.cz

• Ginger Emotional Support app (www.ginger.com)

• Carrott - support on family forming journey (www.get-carrot.com)
  

Our people are the Heart of Accolade 

Together, we are building a great and enduring business that truly makes an impact. At Accolade, we are committed to building a workplace where all can grow and thrive.  We do this by living our core values:  

Member Obsessed 

For everything we do, we ask ourselves: Is this going to make our member’s life measurably better? 

Be Fearless 

We think differently. We do what’s never been done. We are reinventing healthcare every step of the way. 

Stronger Together 

We honor the differences among one another and know that our unique perspectives drive us forward. 

Genuine Care 

We care deeply about the human beings we work with and serve. We have each other’s back.  

Embrace Reality 

We bring the data, tell the truth, and trust each other. 

Relentless Execution 

We operate with a bias for action. Take initiative, move fast & have fun. 

Accolade is committed to being a company that embraces a hybrid work environment where employees can enjoy the best of both worlds - the flexibility to work from home and the opportunity to have a common place to connect, collaborate, and innovate with others in-person.  Our hybrid work model requires that employees who live within 40 miles of an Accolade office are required to be in the office for at least two days during the work week. Accolade will provide reasonable accommodation to qualified employees with disabilities or for a sincerely held religious belief.

Accolade is an Equal Opportunity and Affirmative Action Employer committed to advancing an inclusive environment for all qualified applicants and employees. We provide employment opportunities, without regard, to any legally protected status in accordance with applicable laws in the US. We are committed to help ensure you have a comfortable and positive interview experience. 

Accolade, Inc., PlushCare, Inc., and Accolade 2ndMD LLC will never ask you to pay to get a job. Anyone who does this is a scammer. Further, we will never send you a check and ask you to send on part of the money or buy gift cards with it. These are also scams. If you see or lose money to a job scam, report it to the Federal Trade Commission at ReportFraud.ftc.gov. You can also report it to your state attorney general.

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