Bilingual Appeals and Grievances Analyst
Bright Health, Remote
WE’RE NEW, BUT WE’RE NOT NEW AT THIS.
- Reviews, researches and directs complaints, grievances and appeal cases to appropriate personnel, and follows up to ensure that resolution has occurred, documentation is complete, required time-frames are met, and proper written communication of the decision has occurred. In most cases, prepares the written communication of the decision in plain written language. Coordinates additional follow up activities with appropriate department managers and/or leads and tracks to conclusion.
- Maintains 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.
- Participates in internal committee and interdisciplinary meetings, reporting recent activity and analysis of trends, and makes recommendations for problem resolution and performance improvement
- Monitor all incoming appeal and grievance channels including mail, fax and phone
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- Bachelor’s degree or equivalent work experience preferred
- Three (3) or more years of experience in health plan operations setting required, preferably in Appeals & Grievances or Health Care Customer Service
- Two (2) or more years of MA experience preferred
- Detail oriented
- 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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