Account Assistant 3, Claims

Working at Yale means contributing to a better tomorrow. Whether you are a current resident of our New Haven-based community, eligible for opportunities through the New Haven Hiring Initiative, or a newcomer, interested in exploring all that Yale has to offer, your talents and contributions are welcome. Discover your opportunities at Yale!OverviewIn 1971, Yale University established Yale Health to provide health services to its facility, staff and students through a multidisciplinary health maintenance organization located on campus. Yale Health has more than 50,000 members including students, staff, faculty and their families who come from every state in the country and almost every country in the world. With over 50 years of service to the Yale community, our state-of-the-art facility at 55 Lock Street, is where our members receive most of their care from our 150+ providers. It is a 144,000 square foot medical facility with over 90 exam rooms, an Acute Care Department, a 15-bed inpatient facility with two negative pressure rooms, a diagnostic imaging suite including MR and CT scan, x-ray and ultrasound and a full-service retail pharmacy.The Account Assistant 3 provides operational support to Yale Health the Claims processing team. process function. Responsibilities include:1. Answer member and provider calls regarding claims status and benefits related to a specific claim.2. Review and resolve member issues related to existing claims.3. Knowledge of the YH relationship with Aetna for claims processing.4. Sort all incoming mail and distribute accordingly. Process outgoing checks and outgoing mail.5. Scan and log new paper claims in IDX and file in appropriate folders for processing.6. Mail checks and Explanation of Benefits (EOB)s to providers/members; and appeal Letter and related EOBs to members.7. Comprehensive knowledge of benefits covered under all plans as it pertains to an existing claim.8. Interpret coverage determinations on existing claims including out of area claims.9. Respond to emails from members and providers regarding claims status; complete related provider spreadsheets.10. Respond to Billing voicemails regarding claims.11. Assists in projects related to the Claims Department, as needed. Perform other duties as assigned. Schedule:  Full-time (37.5 hours per week). The typical schedule is Monday–Friday, 8:30 a.m. to 5:00 p.m. Occasional evenings, weekends, holidays, and recess periods may be required, and overtime may be necessary.Hybrid schedule will be considered after successful completion of probationary period and initial competency assessment.Required Skills and Abilities 1. Excellent interpersonal skills and telephone etiquette. 2. Ability to handle a large volume of phone calls. Knowledge of Microsoft products, eg. Word, Excel.  Familiar with medical terminology. 3. Ability to understands and write complex written instructions, memoranda, and policy statements. 4. Ability to problem solve. Excellent communication skills, both verbal and written.6. Strong organizational skills with ability to handle multiple tasks simultaneously.Preferred Skills and AbilitiesKnowledge of CRM – Athena IDX/IndigoPrincipal Responsibilities 1. Receives, classifies, and codes information. Reviews account records to ensure accuracy and completeness. Prepares and distributes billing statements. 2. Obtains and provides information related to accounts, procedures, and regulations. Establishes, maintains, and reconciles account records. 3. Reviews, logs, codes, and posts payments. Identifies and corrects errors. Totals and reconciles cash transactions daily. Monitors account records. Composes correspondence related to problem accounts. 4. Refers delinquent accounts to supervisor and collection agencies. Researches individual accounts. May summarize findings in brief reports. 5. Completes and processes forms. May present account information at legal proceedings. 6. Performs clerical functions incidental to account activity. Required Education and Experience Four years of related work experience, two of them in the same job family at the next lower level, and a high school level education; or two years of related work experience and an Associate's degree; or an equivalent combination of experience and education.Job Posting Date06/25/2026Job CategoryAdministrative SupportBargaining UnitL34Compensation GradeLabor Grade CCompensation Grade ProfileHourly Range$28.43Time TypeFull timeDuration TypeStaffWork ModelOn-siteBackground Check RequirementsAll candidates for employment will be subject to pre-employment background screening for this position, which may include motor vehicle, DOT certification, drug testing and credit checks based on the position description and job requirements. All offers are contingent upon the successful completion of the background check. For additional information on the background check requirements and process visit "Learn about background checks" under the Applicant Support Resources section of Careers on the It's Your Yale website.Health RequirementsThis role is a healthcare worker position. Healthcare workers (HCW) are defined as university employees working a healthcare setting who have the potential for direct or indirect exposure to patients, human research subjects or infectious materials including body substance, contaminated medical supplies, devices and equipment, surfaces, or air.  HCW have specific health requirements that must be met prior to starting work, including MMR vaccine or immunity, varicella (chickenpox) vaccine or immunity, TB screening, COVID vaccine according to University policy, hepatitis B vaccine or immunity, and annual flu vaccination.Posting DisclaimerThe hiring rate of a role is determined in accordance with the provisions outlined in the respective collective bargaining agreement.The intent of this job description is to provide a representative summary of the essential functions that will be required of the position and sh