“Making Healthcare Right. Together.” is the cornerstone of all we do. Our vision is through powerful relationships with Care Partners, we help all people live healthy and brighter lives. To successfully achieve our mission and vision as we operate in a dynamic health care environment, we expect Bright employees to embody and uphold our core values in work and interactions, both internal and external: be brave, be brilliant, be accountable, be inclusive, and be collaborative.

SCOPE OF ROLE

The Team Lead, Member Services is responsible for providing exceptional & dedicated support to the MES Team, while demonstrating & incorporating the Bright values into day to day operations.

ROLE RESPONSIBILITIES

The Team Lead, Member Services job description is intended to point out major responsibilities within the role, but it is not limited to these items.

1. Collaborates or assists with internal and external Bright Health Partners to resolve Enrollment, Eligibility, Billing, and Underwriting issues.

2. Provides support to MES team in the areas of collecting outstanding premiums, working with State-based exchange or Federal Facilitated Marketplace (FFM) to resolve enrollment, grace-period, premium, billing, APTC/CSR disputes or discrepancies.

3. Assist or support MES team to review all incoming enrollment quarantine items to determine whether the enrollment may be accepted, requires additional information or should be rejected.

4. Participates as needed in the discovery and resolution of root cause for recurring issues.

5. Ensure that all customer needs and problems are properly communicated and managed in a way that maintains great customer relationships.

6. Communicate directly with members to discuss impact due to retroactive changes received from state-based exchange.

7. Monitor calls and QA mentor, make decisions and deliver Performance Improvement Plan Action (or similar), approve/deny PTO, maintain 24 TAT for all tasks, train on systems, perform DLP maintenance, lead weekly team meetings and monthly 1:1s.

8. Analyze and report daily/weekly/monthly metrics.

9. Other duties and responsibilities as assigned.

SUPERVISORY RESPONSIBILITIES

This position has supervisory responsibilities.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

· High School diploma or GED required.

· Three (3) years of IFP and/or FFM Health Insurance Industry required.

· Three (3) to five (5) years of customer service experience required.

· Claims or 834 EDI File experience preferred, but not required.

· Two (2)+ years of leadership experience required.

· Call monitoring and QA mentoring experience preferred but not required.

· Experience with Performance Improvement Plans or similar required.

· Experience with classroom and/or individual training sessions required.

PROFESSIONAL COMPETENCIES

· Strong communication skills, both verbal and written

· Organized and be able to prioritize work to meet deadlines

· Works independently with little supervision

· Able to thrive in an often-chaotic environment

· Understands regulatory and compliance rules surrounding enrollment and eligibility

· Results and detail oriented and understands the big picture

· Able to work independently with little supervision

· Able to thrive in an often-chaotic environment

· Able to understand regulatory and compliance rules surrounding enrollment and eligibility

· Results and detail oriented

· To be positive and accountable

· Team Unity

 BEHAVIORAL AND LEADERSHIP NORMS

· Bright Values: Lives the Bright Values. Is focused on positivity and respect in all service interactions. Is focused on bravery needed to develop a variety of skills. Not afraid to ask questions. Focus on the team’s successes, and how to support that effort.

· Collaboration: Is an effective collaborator that works well with the functional team and others in the organization to align on timelines and effective delivery of a project or task. Is solution oriented. Is able to work with different personality types and teammates to overcome differences in opinion and thought to achieve common company goals.

· Delivers Results: Is results oriented. Focuses on results and the best and most efficient avenue for achieving results. Helps to create process and follows process to achieve results. Ensures thorough documentation of work and process. Works with manager on goal setting to ensure timely and high-quality work product. Is focused on managing against a predetermined set of objectives.

· Exhibits Curiosity: Focuses on learning about the business at large. Seeks to understand how they can contribute to driving the business forward and how the bigger picture works. Actively participates in his/her own career development.  

· Multi-tasking: Balances multiple work projects and tasks at any given time. Alongside manager or appropriate Bright teammate, re-evaluates priorities based on changing company needs to understand what must be done today. Consistently meets deadlines.

· Service Mindset: Has an outlook that focuses on creating customer value, loyalty and trust. Responds promptly to customer and business needs. Goes above and beyond simply providing service, to build relationships with customers and anticipate needs.

· Upward Management:  While balancing multiple work projects and tasks, successfully manages expectations with appropriate project owner about capacity, challenges and barriers to success. Is not afraid to ask for help, guidance or feedback.

 LICENSURES AND CERTIFICATIONS

· Producer licensing for Health & Accident may be required in the state in which an individual resides for OEP 2020 or before an individual will be able to transition into a FTE MES role. (Potential temp to FTE is a minimum of 6 months.)

WORK ENVIRONMENT

· Most work responsibilities are performed in an open office setting, carrying out detailed work sitting or standing at a desk/table and working on the computer. Some travel may be required.

· Live by the Bright values to maintain a strong, collaborative culture

· Be a role model for the team as to why Bright Health is truly a “Great Place To Work”

 EEO/AFFIRMATIVE ACTION STATEMENT

As an Equal Opportunity/Affirmative Action 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.

ABOUT US

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 Modern Healthcare and Forbes, etc. But more than anything, we're a group of people who are really dedicated to our mission in healthcare. Come join our 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.

BRIGHT ON!