Case Spec - GAU
Case Spec - GAU
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$ 52800 - 65800
1 Vacancy
Job Description
Pay Range:
$52800.00 - $65800.00Please emailif you are a candidate seeking a reasonable accommodation for the application and/or interview process.
At BCBSRI our greatest resource is our people.
We come from varying backgrounds different cultures and unique experiences. We are hard-working caring and creative individuals who collaborate support one another and grow together. Passion empathy and understanding are at the forefront of everything we donot just for our members but for our employees as well.
We recognize that to do your best work you have to be your best self.
Its why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health dental and vision insurance as well as programs that support your mental health and well-being. We pay competitively offer bonuses and investment plans and are committed to growing and developing our employees.
Our culture is one of belonging.
We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where youre at in the organization youre an integral part of our team and your input thoughts and ideas are valued.
Join others who value a workplace for all.
We appreciate and celebrate everything that makes us unique from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders.
Were dedicated to serving Rhode Islanders.
Our focus extends beyond providing access to high-quality affordable and equitable care. To further improve the health and well-being of our fellow Rhode Islanders we regularly roll up our sleeves and get to work (literally) in communities all across the statebuilding homes working in food pantries revitalizing community centers and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can our associates receive additional paid time to volunteer.
What youll do:
Investigate and resolve member and provider complaints benefits appeals and administrative appeals for all company products. Maintain documentation of cases.
Respond to internal and external inquiries assist with special member cases and suggest resolutions via telephone or written communication.
Assist members gain a better understanding of the plan through education.
Identify potential quality of care issues; escalate as appropriate.
Collaborate with internal areas to perform trend analysis; identify reasons for appeals and determine if a review of corporate policies procedures or product design is necessary.
Participate in departmental audits in preparation of regulatory site visits.
Participate in department initiatives and projects.
Perform other duties as assigned.
What you need to succeed:
High school degree
Two to four years experience in a managed care environment
Proficiency with Microsoft Suite of products; i.e. Word Excel PPT Teams Sharepoint; Office etc
Systems/SoftwareSalesforce (system of record for appeals and grievances) Outlook Prime Rx FACETS MacessPrior health insurance industry experience (Customer service Claims Systems)
Required Knowledge Skills and/or Abilities:
Knowledge of health insurance laws and regulations
Working knowledge of Microsoft Office including Excel and Word
General computer proficiency
Written and verbal communications skills
Good organization skills
Time management skills
Detail oriented
Ability to research and organize data
Ability to organize work efficiently to meet established time and quality standards
Location:
BCBSRI is headquartered in downtown Providence conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules based on role:
- In-office: onsite 5 days per week
- Hybrid: onsite 2-4 days per week
- Remote: onsite 0-1 days per week. Permitted to reside in the following states pending approval from the Human Resources Department: Arizona Connecticut Florida Georgia Louisiana Massachusetts North Carolina Oklahoma Rhode Island South Carolina Texas Virginia
Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do and it strengthens our ability to meet the challenges of todays healthcare industry. BCBSRI is an equal opportunity employer.
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Employment Type
Full-Time
