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“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 Bilingual Member and Provider Services Representative role is to work directly with members and providers to establish rapport/connection and build confidence in Bright Health. This will include members who come to the Bright office as well as callers (members and providers) who are referred by our business partners. As a Member and Provider Services Representative, they identify and rectify any complicated member or provider issues relating to Bright Health’s insurance benefits, claim processes, or enrollment and premium billing processes for all lines of business.
The Member and Provider Services Representative job description is intended to point out major responsibilities within the role, but it is not limited to these functions:
1. Partner with Bright members and providers to research and resolve escalated and complex member or provider issues, by phone, over chat, or in person. Collaborate across the organization to resolve complicated issues including, Claims, Enrollment, Billing, Provider Relations, Utilization Management, Sales, Broker Services, and all vendors. Properly recognize and triage complaints, grievances and appeals in a timely manner
2. Assist in researching, resolving and responding to social media escalations.
3. Retain “at risk” members
4. Complete outbound call campaigns to welcome members, check in with members, build connection, and address special risk issues (Out of Network utilization, wellness opportunities), etc.
5. Develop additional processes to further connect with the Bright Health members and providers. Complete various outbound call campaigns such as Welcome Calls, Check-In Calls, Special outbound call projects for high-risk members or providers.
6. Participate in the development and maintenance of policies and procedures relative to Customer Experience.
7. Serve as a listening post to understand the voice of the Bright Health Customer and contribute ideas to improve the experience.
8. Other duties and responsibilities as assigned.
This position does not have supervisory responsibilities.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
· High School diploma or GED required, Bachelor’s Degree preferred
· Three (3) or more years of health insurance payer experience
· Three (3) or more years of direct customer service support
· Must have strong communication skills (verbal and written)
· Must be highly organized and be able to prioritize work to meet deadlines
· Must be successful working in an environment of ambiguity and change
· Display strong strategic behaviors such as initiative, problem solving, critical thinking, judgment, innovation and independence
· Ability to influence and collaborate with business partners throughout the organization.
LICENSURES AND CERTIFICATIONS
· No licensures and/or certifications are required.
The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. Some travel may be required.
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.
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.
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