Appeals Analyst

Bind Minneapolis , MN 55415

Posted 2 weeks ago

Bind was formed in 2016 by veteran health insurance innovators passionate about making health insurance personal - with the clarity, flexibility and power people deserve.

Want to move mountains?

Bind took the old model of health insurance apart and is rebuilding it - from floor to ceiling, from studs to rafters. We're not iterating a tired design or nudging a change-resistant industry, we're delivering what people want now - clear prices, timely support, personal choice and flexibility and an awesome, intuitive experience.

Where different wins.

Help build different and make a difference. Become a Binder and help us revolutionize health insurance.

Appeals Analyst

Summary

We are adding an Appeals Analyst to our growing team! The Appeals Analyst ensures member appeals are responded to in a professional and customer-focused manner and completed according to state and federal mandates and within SLAs. Perform research that leads to the resolution of assigned cases, management of appropriate follow-up activities and ensures accurate and timely reporting and documentation of cases; analyzes and reports on trends and supports process and experience improvement. Focus, enthusiasm, and a dedication to excellence are all personal characteristics highly valued at Bind.

Responsibilities

  • Perform system and related investigation into appeals by researching sources to establish facts for case review.

  • Resolve or provide recommendations on appeals by applying critical thinking, sound judgment; interprets and applies benefit plan documents, internal policies and procedures, and state and federal guidelines.

  • Consult and present information to internal departments, committees and senior management as needed to resolve high profile, complex appeals and complaints.

  • Coordinate additional follow up activities with appropriate teams, ensure resolution has occurred, documentation is complete, required time frames are met, and proper communications.

  • Document processes and findings within appropriate case logs, and other internal tracking systems, and maintain grievance and appeal case files as required by programs, state and federal mandates.

  • Provide comprehensive and timely responses to member issues, including those involving sensitive or highly visible issues; prepares communication of decisions in plain written language following all applicable state and federal mandates

  • Interpret and apply department policies and procedures and assist with applicable laws, rules, and regulations; ensure process and operation compliance and receive guidance within these areas as needed.

Requirements

  • Bachelor's degree in related field and at least five (5) years of combined progressive experience in health plan member service center, escalated service team and appeals; or equivalent education and experience.

  • Experience responding to member complaints, grievances and appeals.

  • Knowledge of principles, practices and techniques within health care plan operations.

  • Experience in research and analyzing medical details and claim information.

  • Methods to research medical information and claim details.

  • The administration and oversight of plan programs, policies and procedures.

  • Health care insurance programs and coordination.

  • Develop and apply case management/appeals approaches or concepts.

  • Recommend and/or resolve questions and appeals.

  • Perform professional-level appeal duties in a variety of assigned areas.

  • Project management principles and practices.

  • Applicable laws, codes and regulations.

  • Process improvement principles and programs.

  • Ability to work independently and maintain a high level of initiative.

  • Handle confidential information with discretion.

  • Perform multiple concurrent projects with firm deadlines.

  • Communicate effectively and build relationships at all levels of the organization.

  • Be flexible, adapt to change.

  • Present and coordination information across multiple groups.

  • Serve as a team member and own the development and management of projects.

  • Operate in both a team and individual contributor environment.

  • Interpret, apply and explain applicable laws, codes and regulations.

  • Prepare functionals reports, correspondence and other written materials.

  • Use initiative and independent judgment within established department guidelines.

Preferred Qualifications

  • Experience with Hyland or Kiriworks A&G tracking system

  • Startup experience

  • Working in an ambiguous, fast-paced environment

  • Agile, ready to change direction on the fly

What We're Offering

  • Chance to join a new tech start-up aiming to fix the healthcare industry

  • Empowerment to shape new solutions disrupting healthcare while providing benefits and choice to its members

  • Flexible work-from-home schedule to support work-life balance

  • Opportunity to work with people who are motivated to go to work every day and make a difference

  • Competitive pay, generous PTO, and the opportunity to be a part of a new health insurance plan powered by the consumer, you!

Diversity creates a healthier atmosphere. Bind is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Bind is a drug-free workplace.

Bind sponsors H-1B visas for current H-1B visa holders on a limited basis, other visa sponsorship not available.

#LI-KM1

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Appeals Analyst

Bind