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Blue Cross and Blue Shield of Minnesota · 2 days ago

Appeals & Grievance Liaison Associate

United States

Full-time

Remote

Entry Level

$21.64/hr - $32.46/hr

1+ years exp

Blue Cross and Blue Shield of Minnesota is committed to transforming healthcare and is seeking a dedicated Appeals & Grievance Liaison Associate. This role focuses on managing the appeals process by assigning cases, conducting preliminary research, and collaborating with internal partners to ensure compliance with service level agreements and regulatory requirements.

Insurance

Comp. & Benefits

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

Qualification

Regulatory policiesResearchAnalysisCommunication skillsPC software proficiencyOrganizational skillsTeamworkAdaptabilityProblem-solving

Required

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

Claims and/or Customer Service knowledge

Understanding of the appeal validation process

Benefits

Medical, dental, and vision insurance

Life insurance

401k

Paid Time Off (PTO)

Volunteer Paid Time Off (VPTO)

And more

Company

Blue Cross and Blue Shield of Minnesota

Glassdoor4.0

About Blue Cross Blue Cross and Blue Shield of Minnesota is a taxable, nonprofit organization with a mission to make a healthy difference in people’s lives.

Founded in 1933

Eagan, Minnesota, USA

1001-5000 employees