ABOUT THE ROLE
The Quality Assurance Auditor, Appeals and Grievances will ensure that Bright Health responds to complaints, grievances, and appeals in a timely, professional, and customer-focused manner, and completed according to state and federal regulatory standards. This position will be responsible for auditing cases to ensure documentation meets regulatory and state guidelines as well as trains and coaches A&G Team members and internal departments, as necessary.
- Complete random case audits for all IFP/Commercial A&G Team members
- Provide coaching, and training, to all new hires and to A&G staff when errors are received
- Work closely with leadership and colleagues to ensure TAT, quality scores and other A&G goals are met
- Provide daily, weekly, and monthly reporting
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- High School Diploma or equivalent required; Bachelor’s degree preferred
- Two (2) years of experience working in Appeals and Grievances experience required
- Three or (3) or more years of experience in health plan operations setting require.
- Auditing experience preferred.
- Ability to participate in the discovery and resolution of root cause for recurring issues
- Strong communication skills, both verbal and written
- Organized and able to prioritize work to meet deadlines
- Able to work independently with little supervision
- Able to thrive in an often-chaotic environment
- Able to understand regulatory and compliance rules surrounding appeals & grievances
- Results and detail oriented
At Bright Health, we brought together the brightest minds from the health care industry and consumer technology and together we created Bright Health: a new, brighter approach to healthcare, built for individuals. Our plans are easy to manage, personalized and more affordable, giving people the quality care they deserve. Through our exclusive care partnerships with leading health systems in local communities we are reshaping how people and physicians achieve better health together.
We’re Making Healthcare Right. Together.
We've won some fun awards like: Great Places to Work, Modern Healthcare, Forbes, etc. But more than anything, we're a group of people who are really dedicated to our mission in healthcare. Come join our growing team!
As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of Bright Health, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.