Claims Analyst at Bright Health

| Remote
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ABOUT THE ROLE
The Claims Analyst assists with oversight of claims processing, verifying information on submitted claims, reviewing the policy to determine which charges are eligible for reimbursement, auditing any vendor processed claims. They ensure all business rules set by Bright Health Plan are followed by vendors and that payments are made according to CMS guidelines, Bright Contract and plan benefit designs. The Claims Analyst participates in audits, coordinating with Compliance and Legal to ensure Bright Health Plan provides all the requested data, navigate systems as needed during audit and provide any follow up requested by auditors.

YOUR RESPONSIBILITIES

  • Partner with Configuration Provider Data, Network and vendors to ensure claims are paid to providers and members accurately
  • Monitor policies and procedures for Bright Health with claims
  • Monitor daily reporting distributed by vendors (claim reports, document aged reports)
  • Provide recommendations on the design of claim payment system configuration
  • Serve all stakeholders through continuous monitoring and auditing of claim processing, educational and problem-solving support
  • Maintain daily contact with operations management, clinical leadership, and appropriate company leaders
  • Handle adverse and politically difficult situations, as payment accuracy has a significant impact on the financial performance of the organization and our providers, processes related to claims processing, managed care negotiations along with directly impacting the financial performance of Bright Health Plan
  • Read, interpret, and formulate complex computer system rules and managed care reimbursement payment methodologies including but not limited to CMS payment rules and requirements

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

  • Bachelor’s degree in Business Administration or related field required
  • 3-5 years of experience in Enrollment, Premium Billing, Claims, Member and Provider Service, and Appeals at a health insurance company will be considered in lieu of a degree
  • 3-5 years of experience in commercial facility and professional pricing methodologies (DRG, case rate, per diem, % of billed, fee schedule, etc.) and application of CMS billing guidelines required
  • 3-5 years of health care systems and inter/intra-relationships specific to value based contracting activities required
  • 3-5 years of complex managed care concepts/processes, and health insurance pricing and associated benefit design knowledge required
  • Intermediate or advanced Excel skills for data analysis required

PROFESSIONAL COMPETENCIES

  • Able to create and maintain strong working relationships
  • Complex problem-solving skills
  • Able to manage resources in a matrix environment, communicating and influencing effectively at all levels of the organization.
  • Effective at vendor negotiations and relationship management
  • Broad knowledge of health insurance and services delivery and functions
  • In-depth knowledge of federal, state and CMS based requirements and the ability to develop, distribute and administer Medicare programs in a compliant manner
  • Success managing multiple initiatives and priorities simultaneously
  • Able to quantify impact and ROI of initiatives
  • Experience in government programs including Exchanges, Medicare and/or Medicaid
  • Experience with integrating health plan support services and other elements of operations in high-growth environment
  • Certified commercial medical billing coder a plus

ABOUT US
 
At Bright Health, we brought together the brightest minds from the health care industry and consumer technology and together we created Bright Health: a new, brighter approach to healthcare, built for individuals. Our plans are easy to manage, personalized and more affordable, giving people the quality care they deserve. Through our exclusive care partnerships with leading health systems in local communities we are reshaping how people and physicians achieve better health together.
 
We’re Making Healthcare Right. Together. 
We've won some fun awards like: Great Places to Work, Modern Healthcare, Forbes, etc. But more than anything, we're a group of people who are really dedicated to our mission in healthcare. Come join our growing team!
 
As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of Bright Health, our consumers, and the communities we serve. 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.
BRIGHT ON!

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Technology we use

  • Engineering
  • Product
    • .NETLanguages
    • C#Languages
    • JavaLanguages
    • JavascriptLanguages
    • PythonLanguages
    • ScalaLanguages
    • SqlLanguages
    • PowerShellLanguages
    • D3JSLibraries
    • ReactLibraries
    • ReduxLibraries
    • FlutterLibraries
    • ExpressFrameworks
    • Node.jsFrameworks
    • MongoDBDatabases
    • MySQLDatabases
    • PostgreSQLDatabases
    • InVisionDesign
    • SketchDesign
    • Lucid ChartDesign
    • JIRAManagement
    • Microsoft ProjectManagement

Location

We are downtown at 515 Congress Avenue, right in the heart of downtown! Tons of restaurants and close to public transportation.
Making Healthcare Better For All At Bright Health
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An Insider's view of Bright Health

What’s the vibe like in the office?

The office has a relaxed and laid back vibe but people are very serious about their work - perfect!

Anthony

Data Engineer

What does your typical day look like?

My day is so varied, given how quickly we're growing, which is fulfilling for me. I have a good balance of strategic and tactical work in my day as well as time to focus and time to collaborate.

Jen

VP, Digital

What makes someone successful on your team?

A hard-working team player who thinks first and codes next is likely to learn a lot and quickly become a valuable member of the team. Lots of experience with some of our tooling is always nice, but if someone can't knowledge-share well or responds poorly to code reviews and other requests for collaboration, it'll be a tough fit.

Brian

Software Engineer 3

How do your team's ideas influence the company's direction?

We hire smart individuals who thrive on accomplishment and purpose. Our teams are exposed to the bigger picture through constant communication and dialogues – that encourages them to come up with innovative solutions to problems. We've made significant adjustments on our direction in technology and process that were initiated by the team.

Abdullah

VP, Engineering

What are Bright Health Perks + Benefits

Bright Health Benefits Overview

We have 3 different health insurance plans, all through Cigna (HDP, Premium HDP and PPO). We cover the majority of the cost for the employee and some cost for family. We have two dental plans and a vision plan as well. We put 3% of your total earnings into your 401K plan and you are immediately vested in that. We have all the latest technology (Mac or Surface laptops – your choice) to use including standing desks. Fully stocked fridge with snacks and drinks.

Culture
Volunteer in local community
Partners with Nonprofits
Bright Health, is proud to be a founding partner of the Healthy Living Coalition addressing global nutrition and food insecurity.
Friends outside of work
Eat lunch together
Daily stand up
Open door policy
Team owned deliverables
Team based strategic planning
Group brainstorming sessions
Pair programming
Open office floor plan
Diversity
Highly diverse management team
Unconscious bias training
Diversity manifesto
Mean gender pay gap below 10%
Diversity Employee Resource Groups
Hiring Practices that Promote Diversity
Health Insurance & Wellness Benefits
Flexible Spending Account (FSA)
Bright Health employees can contribute up to $3500 annually to their FSA.
Disability Insurance
Dental Benefits
Vision Benefits
Health Insurance Benefits
Life Insurance
Wellness Programs
Bright Health is proud to offer a wellness stipend of $200/month to all employees!
Onsite Gym
Mental Health Benefits
Retirement & Stock Options Benefits
401(K)
We will put 3% of your total earnings into your 401K plan, even if you don't put anything in. It's a safe harbor contribution.
401(K) Matching
Bright Health provides employees with a 401(k) plan managed by Vanguard. We provide a ‘safe harbor’ non-elective contribution equal to 3% of your compensation, regardless of participation in the p
Company Equity
Performance Bonus
Child Care & Parental Leave Benefits
Child Care Benefits
Generous Parental Leave
We provide up to 6 weeks of parental leave for the primary caretaker. We also provide 2 weeks of leave for the secondary caretaker.
Flexible Work Schedule
Bright Health provides employees with a flexible work schedule that includes Core hours, Flexible start and end times.
Family Medical Leave
Company sponsored family events
Bright Health sponsors family oriented events Annually.
Vacation & Time Off Benefits
Generous PTO
Paid Holidays
Paid Sick Days
Perks & Discounts
Casual Dress
Commuter Benefits
Stocked Kitchen
Happy Hours
Happy hours are hosted on occasion.
Relocation Assistance
Fitness Subsidies
Bright Health employees are eligible for discounts on several gym memberships.
Home Office Stipend for Remote Employees
Professional Development Benefits
Diversity Program
Lunch and learns
Promote from within
Time allotted for learning
Customized development tracks

Additional Perks + Benefits

Bright's primary goal is to offer employee benefits and perks that are as flexible as possible to meet each employee's unique needs!

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