Bilingual Appeals and Grievances Coordinator
Bright Health, Minneapolis, MN
WE’RE NEW, BUT WE’RE NOT NEW AT THIS.
- 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.
About Bright Health
Here’s the great thing about building a health plan from the ground up. We get to ask "why" at every turn – and make every decision a thoughtful one. But we’re different than other new health insurance companies because we come from big places. Our leaders have decades of experience working in health insurance and are committed to improving the customer experience. They started Bright Health because they know what to do and, more importantly, what not to do when creating a system that will actually work in your favor. Bright Health believes healthcare can be done better. Our carefully selected network: When we sat down to design Bright Health plans, we were thinking about relationships – the one between you and your doctor, and also the one between us and your doctor. Then we set out to create purposeful partnerships with caring providers. We call them our Care Partner. Our tight-knit network gives you access to a community of compassionate providers who are working together with us and with each other to help you live Brighter. Our commitment to service: When you need care, you want someone familiar who can help you, someone who actually feels good to interact with. And in-between visits to the doctor, you want someone who will help you thrive. So with any Bright Health plan, you get us, your Bright Health Team. We’re here, ready to help. No matter if your question is “Can I see this doctor?” or “How much is covered?” it’s easy to reach a real person who can get you the right answers and help you find the right care. There, that’s better. Our Whole Health Rewards: Keeping good health extends far beyond how many steps you take, what your BMI is, or what kind of food you eat. Don’t get us wrong, those things certainly contribute to your well-being but there’s a whole lot more to the picture. We provide opportunities for you to earn $$ throughout the year for making good decisions that lead to a Brighter life. When you and your health plan both want what’s best for you – it makes staying well a whole lot easier.
Want to learn more about Bright Health? Visit Bright Health's website.
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