Claims & Benefits Specialist

Prague
Full-time

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.

Working hours: 13.30-22.00 (Mon-Fri)

Start date: 1st July 2025

Contract limited to 1 year (possibility to extend)

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)

Valid work permit (free access to Czech labor market / NO Employee cards) is must-have requirement.

Do you want to know more about us?

Office address: Rohanskeho nabrezi 717/4, Prague 8 Karlin (Krizikova metro/tram stop)

Check out 👇 :

Our Instagram 📷 @we_are_accolade_prague