ABOUT THIS ROLE
The Member and Provider Services Specialist’s 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 Specialist, 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.
- Partner with Bright members and providers to research and resolve complicated member or provider issues, by phone, over chat, or in person.
- Assist in researching, resolving and responding to social media escalations.
- Collaborate across the organization to resolve complicated issues including, Claims, Enrollment, Billing, Provider Relations, Utilization Management, Sales, Broker Services, and all vendors.
- Retain “at risk” members
- 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.
- Properly recognize and triage complaints, grievances and appeals in a timely manner
- Develop additional processes to further connect with the Bright Health members and providers.
- Participate in the development and maintenance of policies and procedures relative to Customer Experience.
- Assist in training of front-line Member and Provider Service Staff.
- Complete various outbound call campaigns such as Welcome Calls, Check-In Calls, Special outbound call projects for high-risk members or providers.
- Serve as a listening post to understand the voice of the Bright Health Customer and contribute ideas to improve the experience.
EDUCATION, TRAINING, AND PROFESSIONAL EXPEREINCE
- 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.
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.
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.
Bright Health is tripling its footprint in 2019 to offer a variety of health insurance plans to more individuals. Bright Health operates health insurance offerings across Individual and Family Plan segments and the Medicare Advantage space in Alabama, Arizona, Colorado, Ohio, New York and Tennessee.
We’re Making Healthcare Right. Together.
We've won some fun awards like: Great Places to Work
, Modern Healthcare
, etc. But more than anything, we're a group of people who are really dedicated to our mission in healthcare. Come join our growing 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.