At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day.

                        

We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One.

                                    

Job Title

Employee Health Plan Specialist I

                        

Location

Cleveland

                    

Facility

Remote Location

                     

Department

Employee Health Plan-Caregiver Office

                      

Job Code

B99933

                     

Shift

Days

                       

Schedule

8:00am-4:30pm

                       

Job Summary

                         

Job Details

Join the Cleveland Clinic team where you will work alongside passionate caregivers and make a lasting, meaningful impact on patient care. Here, you will receive endless support and appreciation while building a rewarding career with one of the most respected healthcare organizations in the world.  

As an EHP Specialist, you will perform various HR-related tasks for the Employee Health Plan (EHP) Program. In this role, you will offer exceptional customer service, offering support, answers and referrals to callers as needed. You will develop extensive experience in de-escalating insurance issues, assisting with denials and more, all while making a positive difference in the lives of your fellow caregivers. 

A caregiver in this role will work 8:00 a.m. – 4:30 p.m., 100% remote after 6 weeks of on-site training at the Cleveland Clinic Administrative Campus in Beachwood, Ohio.

A caregiver who excels in this role will:  

• Provide customer service regarding EHP health insurance benefits, eligibility and the Healthy Choice premium discount program. 
• Answer incoming phone calls, responding to correspondences from EHP members, providers, vendors and internal departments.  
• Utilize Workday, Core, Epic, SharePoint, Third Party Administrators (TPA) system(s), Healthy Choice Portal and all associated databases to resolve issues related to registration, insurance company authorization requirements, billing, insurance company explanation of benefits, provider-based billing, claim processing, coding and collections 
• Collect payments, ensuring dollar amounts are posted to the correct debit and according to the patient request. 
• Identify issue(s) and resolve issues or refers to appropriate staff for resolution. 
• Refer members to correct area for dental, vision, life event changes and other Human Resources related issues. 
• Perform other duties as assigned by EHP management, complete regular audits in the Healthy Choice database and perform appeal process for members in Healthy Choice. 
• Answer EHP Medical Management Department communications, respond to EHP prior-authorization requests/status and appeal or peer to peer policies. 
• Advise members/providers of provider network and prior authorization/post service medical necessity requirements. 
• Advise members about general Healthy Choice and Coordinated Care program topics. 
• Initiate Healthy Choice enrollment cases and initiate Healthy Choice diagnosis/premium appeals on member’s behalf. 

Minimum qualifications for the ideal future caregiver include:  

• High School Diploma/GED 
• Two years of experience in health insurance claims processing, customer service, collection call center or medical facility OR three years customer service interacting with the public by telephone or in person in a similar role or capacity or related experience 
• Previous customer service or billing experience. 
• PC skills proficiency 

Preferred qualifications for the ideal future caregiver include:  

• Basic understanding of Coordination of Benefits, Willis dependent audit and Cobra process 
• Basic understanding of interpreting Explanation of Benefits statements, claim payments and/or denials 
• Formal office training  
• Experience with EPID 
• Knowledge of provider networks

Our caregivers continue to create the best outcomes for our patients across each of our facilities. Click the link and see how we’re dedicated to providing what matters most to you: https://jobs.clevelandclinic.org/benefits-2/  

Physical Requirements:

• Ability to sit for prolonged periods of time.
• Ability to work and move among all locations of the EHP Administrative Office.
• Excellent hand/eye coordination.
• Manual dexterity to operate personal computers and standard office machines.
• Visual acuity, hearing and speaking to transfer information from paper to computer, from computer to computer, and to communicate in person and on the telephone.
• Ability to work in general office working conditions.
• Good written and verbal communication skills required.

Personal Protective Equipment:

• Follows standard precautions using personal protective equipment as required.

                       

The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. All offers of employment are follwed by testing for controlled substances and nicotine. All new caregivers must clear a nicotine test within their 90-day new hire period. Candidates for employment who are impacted by Cleveland Clinic Health System's Smoking Policy will be permitted to reapply for open positions after one year.

Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption.

Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility. 

Please review the Equal Employment Opportunity poster. 

                  

Cleveland Clinic Health System is pleased to be an equal employment employer: Women / Minorities / Veterans / Individuals with Disabilities