Consumer & Provider Liaison I: Appeals and Grievances

Blue Cross Blue Shield of Minnesota•Eagan, MN

7d•Remote

About The Position

About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You Will Have This position is responsible for researching, analyzing and responding to written and verbal appeals and grievances from members and providers. This position provides proactive involvement researching and recommending modifications to materials and processes to satisfy regulatory and business standards. Works collaboratively with team members and internal business partners on problem resolution and process improvement opportunities.

Requirements

2+ years' related experience or Bachelor’s degree.
All relevant experience including work, education, transferable skills, and military experience will be considered.
Knowledge of state and/or federal regulatory policies and/or provider agreements, and a variety of health plan products.
Demonstrated ability to write clear, concise and grammatically correct materials with ability to express complex concepts in simple terms.
Excellent verbal communication skills with the ability to express complex concepts in lay terms.
Demonstrated ability to research, analyze, problem solve and resolve complex issues.
Demonstrated strong organizational skills with ability to manage priorities and change.
Demonstrated ability to work independently and in a team environment.
Proficient in multiple PC based software applications and systems.
Adaptable and flexible with the ability to meet deadlines.
High school diploma (or equivalency) and legal authorization to work in the U.S.

Nice To Haves

Claims coding and pricing knowledge/experience.

Responsibilities

Research appeals and grievances ensuring plans and internal policies are followed to make the initial determination.
Assist in the preparation of cases for second level appeals for review by the Corporate Appeals Committee and external review organizations.
Assist in the preparation for and representation of the organization in State Fair Hearings.
Collaborate with internal business partners on work groups and in meetings dedicated to process improvements.
Review business rules and processes.
Provide recommendations to modify materials and processes to accurately reflect our internal business practices.
Demonstrate ability to make decisions following plan documents and business rules.
Establish and maintain effective verbal and written communications while developing and maintaining positive working relationships across the organization.
Actively participate in departmental projects.
Positively represent the organization in interactions with our members and providers.