Senior Billing & Insurance Advisor

Overview

Senior Billing & Insurance Advisor provides expert medical billing advocacy and advanced insurance analysis support for members navigating complex healthcare coverage scenarios. This role is responsible for resolving claims issues, reducing out-of-pocket costs, and delivering clear, client-ready insurance guidance across Medicare and private insurance plans. Success in this role is defined by accurate claim resolution, high-quality benefit interpretation, professional advocacy, and consistent case ownership from intake through resolution.

• Billing & Claims Advocacy:
  Resolve unpaid, underpaid, or denied claims through investigation, follow-up, and escalation
• Track and submit out-of-network claims accurately and on time
• Audit medical bills, EOBs, and payment histories for discrepancies
• Identify billing errors, coding issues, and coverage mismatches impacting balances
• Reduce client costs through reconsiderations, corrected claims, and coordination of benefits
• Prepare and submit appeals with complete documentation and required authorizations
• Follow up on prior authorizations, referrals, and claim statuses
• Maintain detailed documentation, timelines, and accountability for each case
• Serve as a professional advocate between members, providers, and insurance carriers

• Insurance Analysis, Plan Comparison & Enrollment Assistance:
  Interpret plan documents and clearly explain benefits to support informed decision-making
• Provide expert analysis of Medicare and private insurance policies, including exclusions and cost-sharing
• Produce polished, client-ready insurance comparison and recommendation reports
• Guide members through complex scenarios such as referrals, COB, appeals, and plan changes
• Review plan documents, networks, formularies, and coverage rules
• Verify deductible and MOOP exposure where applicable
• Educate members with step-by-step guidance for benefit utilization and issue resolution
• Document recommendations, interactions, and case status in internal systems

• Microsoft Excel: Track claims, payments, balances, timelines, and appeal status
• Microsoft Word: Draft appeal letters, billing correction requests, and summaries
• Microsoft Outlook: Manage high-volume follow-ups and communications
• PDF Tools (Adobe or similar): Review, edit, annotate, and organize bills, EOBs, and forms
• Insurance Carrier Portals & Call Systems: Check claim status, escalate issues, and document outcomes

• Excel: Build side-by-side plan comparisons (premiums, deductibles, MOOP, copays)
• Word: Create professional insurance reports and written recommendations
• Carrier & Network Portals: Perform provider lookups, formulary checks, and benefit reviews
• Medicare Tools: Utilize Medicare.gov resources and enrollment rule references
• CRM Systems (Salesforce): Track cases, document guidance, and manage follow-ups

• Medical Billing & Claims Analysis: Deep understanding of claim flow, denials, and resolution strategies
• Persistence & Follow-Through: Proactive management of long-running cases to completion
• Problem-Solving & Critical Thinking: Adapt strategies when faced with incomplete or conflicting information
• Clear Professional Communication: Explain complex insurance concepts in plain language
• Organization & Case Ownership: Manage multiple active cases with accuracy and accountability
• Policy Interpretation & Insurance Expertise: Advise accurately on coverage rules and limitations
• Analytical Attention to Detail: Identify nuances affecting member outcomes
• Client Education & Advocacy: Reduce anxiety while delivering factual, compliant guidance
• Stakeholder Navigation: Confidently engage carriers, providers, and third parties

• Medicare and Medicaid claims experience
• Commercial insurance experience (Anthem and other major carriers)
• Appeals experience (medical necessity, authorization, coding, timely filing)
• Basic CPT, HCPCS, and ICD coding familiarity
• Medicare plan knowledge (Advantage vs Supplement, SEPs, IRMAA)
• ACA, COBRA, and plan design exposure (HMO/PPO/EPO rules)
• Salesforce experience

• Medical Insurance
• Vision Insurance
• Dental Insurance
• 401(k) Retirement Plan

Our client is a leading financial services organization providing insurance, advice, investments, and asset management solutions. With a global presence and thousands of employees and advisors, the company is committed to helping individuals achieve long-term financial security and healthier lives through innovation, sustainability, and transformation.

Global Technical Talent (GTT) connects top talent with leading organizations across industries. We specialize in delivering workforce solutions that support innovation, growth, and long-term success for both clients and consultants.

Job Number: 26-01078