“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
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 Provider Disputes, updates to current cases, and other inquiries.
- Review and screen new cases for completeness and timeliness. Communicate with providers for additional information when necessary.
- Enter and handoff new cases to Provider Dispute analysts to be worked once intake process is complete.
- Assist in the review and research of dispute 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 Provider Dispute 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- dispute, and other appropriate persons is accurate, consistent, and customer sensitive.
- Prepare member and provider letters
- Other duties and responsibilities as assigned.
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 extemporary customer service and resolving conflicts.
- Self-directed, able to prioritize and takes ownership in projects, cases, and workgroups
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.