Appeals and Grievances Coordinator
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Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.
What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.
If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.
This position will help 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 specifically responsible for monitoring, screening and distributing cases to other team members to ensure accurate and timely working by the Appeals and Grievances team. This position may also assist in the working of cases, depending on incoming volume, and other project based worked assigned to the appeals and grievances team.
- Monitor all incoming channels, including email, phone, and fax for new appeals and grievances, updates to current cases, and other inquiries
- Review and screen new cases for completeness and timeliness
- Communicate with members and providers for additional information when necessary
- Enter and handoff new cases to Appeals & Grievances analysts to be worked once intake process is complete
- Assist in the review and research of complaints, grievances and appeal cases
- Direct to the appropriate personnel, track updates and follow up to ensure that resolution has occurred, documentation is complete, required timeframes are met, and proper written communication of the decision has occurred
- Maintain grievance and appeal case files and include necessary information to log incoming correspondences, tracking dispositions, and maintaining timeliness of resolution as required by state and federal mandates
- Ensures that all information to members, providers, other parties-to-a-complaint, and other appropriate persons is accurate, consistent, and customer sensitive
- Prepare member and provider letters
- High school diploma or GED is required
- Three (3) years of experience in health plan operations setting, for example, Appeals & Grievances, Customer Service or Medical Claims adjudication is required
- Detail oriented
- Ability to quickly learn and navigate new systems and platforms
- Comfortable being on the phone with external parties including but not limited to members and providers
- Thrive in fast-paced environments and have a passion for extemporary customer service and resolving conflicts
- Self-directed, able to prioritize and takes ownership in projects, cases, and workgroups
We are realizing a completely different healthcare experience where payors, providers, doctors, and patients can all feel connected, aligned and unified on the same team. By eradicating the frictions of competing needs, we are making it possible to give everyone more of what they want and deserve. We do this by:
Focusing on Consumers
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
Building on Alignment
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.
Powered by Technology
We employ our purpose built, integrated data platform to connect clinical, financial, and social data, to deliver exceptional outcomes.
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.