About Blue Cross

Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us.

How Is This Role Important to Our Work?

This position is responsible for researching, analyzing and responding to written and verbal appeals and grievances from members and providers. This position provides proactive involvement researching and recommending modifications to materials and processes to satisfy regulatory and business standards. Works collaboratively with team members and internal business partners on problem resolution and process improvement opportunities.

A Day in the Life:

• Research appeals and grievances ensuring plans and internal policies are followed to make the initial determination.
• Assist in the preparation of cases for second level appeals for review by the Corporate Appeals Committee and external review organizations.
• Assist in the preparation for and representation of the organization in State Fair Hearings.
• Collaborate with internal business partners on work groups and in meetings dedicated to process improvements.
• Review business rules and processes.
• Provide recommendations to modify materials and processes to accurately reflect our internal business practices.
• Demonstrate ability to make decisions following plan documents and business rules.
• Establish and maintain effective verbal and written communications while developing and maintaining positive working relationships across the organization.
• Actively participate in departmental projects.
• Positively represent the organization in interactions with our members and providers.

Nice to Have:

• Claims coding and pricing knowledge/experience.

Required Skills and Experiences:

• 2+ years' related experience or Bachelor’s degree. 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.

Make A Difference

Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.

Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.

All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.

Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.