Insurance Specialist

Job Description:

Role Overview:

As a Tier 1 Customer Support Representative in the Insurance Line of Business

(LOB), you will be the first line of support for customers who are new to insurance

billing or seeking help with foundational insurance processes. Your role centers on

guiding healthcare providers through getting started with insurance in the platform,

handling enrollment-related tasks, and addressing general billing inquiries.

You'll be responsible for delivering clear, compassionate, and efficient support to

ensure our users feel confident and capable as they begin their insurance billing

journey.

As a Tier 2 Customer Support Representative in the Insurance Line of Business (LOB), your primary responsibility is to assist customers with complex insurance billing issues, particularly those related to claim processing, rejections, denials, and secondary billing. You'll provide advanced troubleshooting and education to healthcare providers, ensuring accurate submission and resolution of insurance claims. This role demands a strong understanding of insurance billing workflows and the ability to clearly explain technical solutions to providers in a compassionate and timely manner.

Level 1 Primary Responsibilities:

Getting Started Support:

• Respond to new users' inquiries about insurance workflows such as:
• How to file insurance claims
• How to charge clients copays
• How to enroll for Payment Reports (ERAs)
• Guide providers in understanding the insurance credentialing process and how to get credentialed with payer panels.

Enrollment Assistance:

• Assist with uploading, submitting, updating, or terminating enrollment paperwork.
• Answer questions about enrollment status, provide proof of enrollment acceptance, and troubleshoot rejections.
• Support changes involving:
• TPID/submitter IDs
• Change of vendor or clearinghouse
• Selection or addition of payer IDs
• Assist with issues like:
• "Status 400" error messages
• Duplicate NPI assignments in the system
• Troubleshooting Support:
• Resolve primary claim scrub errors and help identify missing or invalid information.
• Provide guidance on Authorization Tracking setup and use.
• Answer basic deductible-related questions using available help center resources.
• Support users with Health Information Exchange (HIE) or HealthConnex related questions, especially for North Carolina providers.

Key Skills & Competencies:

• Strong knowledge of insurance enrollment workflows, payer requirements, and clearinghouse terminology.
• Clear and empathetic written communication skills.
• Ability to break down complex insurance topics into accessible language.
• Proficiency in using support ticketing systems and customer help tools.
• Attention to detail when reviewing and troubleshooting forms and enrollments.

Level 2 Primary Responsibilities:

Claims Troubleshooting:

• Investigate and resolve:
• Claim rejections and denials
• Issues with payers not receiving claims
• Delayed or missing payments
• Provide support for scrub errors and field-specific issues on the CMS-1500 form (e.g., Box 8, Box 24i/24j).
• Assist with rendering taxonomy code and "Accept Assignment" setting discrepancies.

Secondary Insurance Support:

• Guide users through:
• Filing secondary claims
• Entering accurate data to ensure successful secondary claim submission
• Understanding secondary claim workflows and timelines
• Interpret and help customers read Explanation of Benefits (EOBs),
• Electronic Remittance Advices (ERAs), and Payment Reports.
• Troubleshoot issues with missing or incorrect secondary ERAs or Payment Reports.
• Create and manage requests with Eligible when primary EOBs are missing or incomplete.

Special Scenarios:

• Handle Medicare crossover inquiries (e.g., secondary info coming from Medicare).
• Advise customers on timely filing limits and corrected/resubmitted claim procedures.
• Support users with missing Payment Reports and how to locate or request them.
• Provide general guidance on billing profiles (escalate group-specific issues per protocol).

Preferred Qualifications:

• 2+ year in a healthcare or insurance-related customer support role.
• Familiarity with ERA/EOBs, NPIs, payer IDs, and CMS-1500 claim forms.
• Experience working with digital platforms for billing or EHR systems.
• Knowledge of healthcare credentialing or insurance billing basics.
• In-depth familiarity with CMS-1500 forms, clearinghouses, payer requirements, and billing systems.
• Experience working with secondary billing scenarios, Medicare, and payer follow-ups.
• Knowledge of clearinghouse tools such as Eligible and ERA file troubleshooting.