ABOUT THIS ROLE
The Manager, Claims position will work jointly with leadership to develop, grow and manage the commercial claims department, ensuring that internal and external service level agreements are met. In addition, this position has accountability for ensuring that teams comply with all state and federal regulations including those from CMS and multiple state divisions of insurance.
- Manage claims backlog within state specific Clean Claims turnaround times.
- Monitor departmental performance metrics to ensure key performance measures and Service Level Agreements are achieved.
- Conduct Pre-Payment Audit of all high dollar claims.
- Research and respond to Claim Escalations from Provider Relations, Member Services and Clinical Operations.
- Facilitate the research and resolution of claims issues arising from Appeals and Grievances.
- Collaborate with Third-Party Administrator to configure plan benefits and facilitate claim testing.
- Review and correct claims data errors arising from Edge Server rejections.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- High School diploma or GED required; Bachelor’s Degree preferred
- Three (3)+ years’ experience in a supervisory capacity
- Five (5)+ years’ claims processing experience
- Comprehensive understanding of all aspects of claims processing
- Must have strong communication skills (verbal and written)
- Must be highly organized and be able to prioritize work to meet deadlines
- 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.
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.