Bilingual Appeals and Grievances Coordinator at Bright Health
- 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.
- Hand-off 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 Confirmation Letters.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- 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 exemplary customer service and resolving conflicts.
- Self-directed, able to prioritize and takes ownership in projects, cases, and work groups.