Appeals & Grievance Liaison Associate
Share
Job Location:
Hourly Salary:
Posted on:
Vacancies:
Job Summary
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 role will provide an important expansion of our job family structure within Appeals & position will offer visibility into the entire appeals process but it will focus on the most critical aspect of the job getting the work transferred/assigned to the right area or person quickly. This is imperative so we can position ourselves to successfully meet our internal Service Level Agreements (SLAs) external SLA requirements regulatory requirements and contractual obligations. This position is responsible for preliminary high-level research and triaging of cases based on business rules. Individuals in this position work collaboratively with team members and internal business partners on problem resolution and process improvement opportunities.
Your Responsibilities
- Assign cases through the appeals management tool (moving work).
- Research and respond to provider & member inquiries including provider close-out letters and Livanta notifications. Assign executive inquiries support remote cases for member & provider review and research duplicate cases and other duties as assigned to ensure we meet departmental goals.
- Support external audit preparation.
- Work with third party vendors to obtain documents and translation requests
- Respond to incoming faxes deemed urgent. Set up and assign to Liaisons.
- Provide reporting support with daily workbasket counts.
- Perform advanced validation support for appeals & other complex documents using the IBM Datacap workflow system.
Required Skills & Experience
- 1 year of relevant work experience.
- 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.
Preferred Skills and Experience
- Claims and/or Customer Service knowledge.
- Understanding of the appeal validation process.
Role Designation
TeleworkerRole designation definition: Teleworking is working full time remote. Hybrid is a minimum of 2 days onsite. Onsite is full-time onsite.
Compensation and Benefits
$21.64 - $27.05 - $32.46 HourlyPay is based on several factors which vary based on position including skills ability and knowledge the selected individual is bringing to the specific job.
We offer a comprehensive benefits package which may include:
Medical dental and vision insurance
Life insurance
401k
Paid Time Off (PTO)
Volunteer Paid Time Off (VPTO)
And more
To discover more about what we have to offer please review our benefits page.
Equal Employment Opportunity Statement
At Blue Cross and Blue Shield of Minnesota we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to and will not be discriminated against based on any legally protected characteristic.
Individuals with a disability who need a reasonable accommodation in order to apply please contact us at:
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.
Required Experience:
IC
Key Skills
- Presentation Skills
- Time Management
- Clinical Research
- Communication skills
- GCP
- Infusion Experience
- Managed Care
- Hospice Care
- Conflict Management
- Clinical Trials
- Research Experience
- Home Care
