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Member and Provider Services Representative
Ref No.: 21-00136
Location: Austin, Texas
Position Type:Contract
Member and Provider Services Representative
Remote Opportunity
Must work in CST or MST Zone
Multiple Openings

The Member and Provider Services Representative's role is to work directly with members and providers to establish rapport/connection and build confidence. They identify and rectify any complicated member or provider issues relating to insurance benefits, claim processes, or enrollment and premium billing processes for all lines of business.

Role and Responsibilities
  • Partner with members and providers to research and resolve escalated and complex member or provider issues, by phone, over chat, or in person. Collaborate across the organization to resolve complicated issues including, Claims, Enrollment, Billing, Provider Relations, Utilization Management, Sales, Broker Services, and all vendors. Properly recognize and triage complaints, grievances and appeals in a timely manner 65%
  • Assist in researching, resolving and responding to social media escalations. 5%
  • Retain "at risk” members 5%
  • Complete outbound call campaigns to welcome members, check in with members, build connection, and address special risk issues (Out of Network utilization, wellness opportunities), etc. 5%
  • Develop additional processes to further connect with the Bright Health members and providers. Complete various outbound call campaigns such as Welcome Calls, Check-In Calls, Special outbound call projects for high-risk members or providers. 5%
  • Participate in the development and maintenance of policies and procedures relative to Customer Experience. 5%
  • Serve as a listening post to understand the voice of the Bright Health Customer and contribute ideas to improve the experience. 5%
  • Other duties and responsibilities as assigned. 5%

Qualifications and Education Requirements
  • High School diploma or GED required, Bachelor's Degree preferred
  • Three (3) or more years of health insurance payer experience
  • Three (3) or more years of direct customer service support
Preferred Skills
  • Must have strong communication skills (verbal and written)
  • Must be highly organized and be able to prioritize work to meet deadlines
  • Must be successful working in an environment of ambiguity and change
  • Display strong strategic behaviors such as initiative, problem solving, critical thinking, judgment, innovation and independence
  • Ability to influence and collaborate with business partners throughout the organization.