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 outcomes.
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.
SCOPE OF ROLE
The 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:
- 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
- Assist in researching, resolving and responding to social media escalations.
- 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.
- 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.
- Participate in the development and maintenance of policies and procedures relative to Customer Experience.
- Serve as a listening post to understand the voice of the Bright Health Customer and contribute ideas to improve the experience.
- Other duties and responsibilities as assigned.
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.
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.
We’re Making Healthcare Right. Together.
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.