Appeals Grievances Coordinator
Company: Bright Health
Location: California City
Posted on: September 18, 2022
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Our Mission is to Make Healthcare Right. Together. Built upon the
belief that by connecting and aligning the best local resources in
healthcare delivery with the financing of care, we can deliver a
superior consumer experience, lower costs, and optimized clinical
What drives our mission? The company values we live and breathe
every day. We keep it simple: Be Brave. Be Brilliant. Be
Accountable. Be Inclusive. Be Collaborative.
If you share our passion for changing healthcare so all people can
live healthy, brighter lives - apply to join our team.
Provide administrative support to the A&G Department including
filing, scanning, conduct follow-up calls, setting up initial cases
in the Appeals & Grievance module, etc.
Duties and Responsibilities:
- Be at work/cubicle timely based on the work schedule on file
and ready to handle assignments professionally; must follow company
and department guidelines for all time off/vacation/overtime
- Processes, researches and responds to members and authorized
representatives' inquiries regarding appeals and grievances
- phone, fax or mail in accordance with policies and procedures
and regulatory guidelines
- Responsible for investigating and resolving all priority issues
and/or concerns in a timely and efficient manner.
- Answers telephone inquiries and maintains a professional level
of telephone etiquette.
- Responds to any questions from members and authorized
representatives regarding appeals and grievances.
- Must be able to accomplish duties and assignments with minimal
- Input newly received appeals and grievances in the Appeals &
- Make follow-up calls to provider offices to request case
information as needed
- Scan cases into Appeals & Grievance module and associated
- Create and maintain member file
- Handle department faxing
- Check and distribute documents to A&G coordinators
- Maintain file systems
- File member files/cases based on instruction given
- Maintain files and records so they remain updated and easily
- Sort incoming mail and prepare outgoing mail (envelope,
- Monitor stocks of office supplies and report when there are
- High school GED required
- Previous experience in healthcare, customer service or A&G
- Bilingual in Chinese, Vietnamese, Korean or Spanish required
(speaking and reading; writing preferred)
- Proficient knowledge of Microsoft Office
- Very good communication, organizational and multi-tasking
- Ability to follow directions and perform work independently
according to department and senior management standards
- Able to function effectively under time constraints
- Willingness to accept responsibility and desire to learn new
We're Making Healthcare Right. Together.
We are realizing a completely different healthcare experience where
payors, providers, doctors, and patients can all feel connected,
aligned and unified on the same team. By eradicating the frictions
of competing needs, we are making it possible to give everyone more
of what they want and deserve. We do this by:
Focusing on Consumers We understand patient pain points,
eliminating complexity while increasing transparency, for greater
access and easier navigation.
Building on Alignment We integrate and align individual incentives
at all levels, from financing to optimization to delivery of
Powered by Technology
We employ our purpose built, integrated data platform to connect
clinical, financial, and social data, to deliver exceptional
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.
Keywords: Bright Health, Lancaster , Appeals Grievances Coordinator, Other , California City, California
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