Operations Manager - Quality & Appeals
- - Operations
- Minneapolis, MN, USA
- Full Time
Bind is a health technology and services company founded in 2016 and headquartered in Minneapolis, MN with satellite offices in New York and San Francisco. Bind is health insurance for the way we live now. Unlike traditional health insurance that charges you for services you may never need or want, Bind is on demand: pay for what you need, not what you don't, and adjust your coverage when those needs change. Health coverage that's flexible, clear, and intuitive.
We are creative, collaborative, and a little bit fiery. The Bind team is comprised of like-minded individuals passionate about healthcare, and our cause is the collective act of rewiring it. We embrace new ideas. We're more wheel than cog. More spark than smoke. And we are playful and venturesome in our daily mission to render real and refreshing solutions to health insurance that works better for us all.
Quality and Appeals Manager
Bind is actively seeking a highly skilled, motivated, and experienced individual to develop the roadmap and manage implementation of a Quality Improvement program to enable an optimal service delivery experience for an innovative new health insurance product. Delivering these capabilities will require coordinating across all aspects of the organization. Bind is looking for a leader who will pursue a deep understanding of customer needs, identify and prioritize solutions to meet them, and clearly and effectively communicate the needs, the vision, and the solutions both internally and externally. Focus, enthusiasm, and a dedication to excellence are all personal characteristics highly valued in the Bind organization.
This new position will develop, implement and manage the functions of the Bind Quality Improvement program, including management of escalated member issues and appeals.
- Develop and implement a Quality Improvement program for Bind focused on ensuring the Bind benefit is working as designed; identify process controls and metrics to maintain compliant processes.
- Manage the intake, investigation and resolution of all escalated Member issues and Appeals, ensuring all are processed according to regulatory and customer requirements; provide recommendations and updates to the appropriate internal committees and workgroups, including Member Solutions and Member Appeals committees
- Develop member communications, including letters, call scripts, and emails to convey decisions and/or outcomes of the escalated Member issues and Appeals processes, in close collaboration with the Compliance and Legal teams.
- Review and analyze complaint, escalated issues and appeals data, develop and interpret trend reports, identify root cause issues, and work with various committees to identify opportunities for improvement and increased member and provider satisfaction.
- Actively participate in plan sponsor audits and related activities; ensure resolution of any identified findings through corrective action, in collaboration with the Compliance team.
- Collaborate with the Compliance leader to stay up to date on regulations and policies that impact Benefit Administration and Servicing, ensuring changes are implemented as needed across the organization.
- Recommend solutions and work with cross-functional teams to ensure problems are corrected and teams are advised of corrective measures to prevent recurrences.
- 7+ years of healthcare experience
- Minimum of three (3) years of experience in a Managed Care (Health Plan) environment performing appeals reviews/investigation and data analysis or medical claims processing.
- Excellent verbal, written and interpersonal communication skills, including correct grammar and punctuation, as well as the ability to create correspondence, respond to requests in a timely manner, and facilitate the appropriate exchange of information.
- Strong organizational and time management skills with the ability to handle multiple projects required.
- Ability to manage multiple tasks and priorities in a highly dynamic environment, strong problem-solving skills, and exceptional attention to detail.
- Demonstrated ability to drive issues to resolution, think creatively, work independently, and self-motivate.
- Strong analytical skills with an ability to identify and define problems, collect data/information, establish facts, and draw valid conclusions.
- Must possess a high degree of professionalism and business ethics.
- Strong knowledge of insurance terminology and benefit plan coverage and exclusions. Deep understanding of healthcare industry constituents and their needs.
- Ability to identify key opportunities for action in an innovating environment that includes ambiguity and rapid change.
- Knowledge of basic Performance Improvement tools and methodologies.
Bind is committed to providing equal employment opportunities. All qualified applicants and employees will be considered for employment and advancement without regard to race, color, religion, national origin, sex, disability, age, marital status, sexual orientation, veteran status, genetic information, or any other status protected by applicable law.