ABOUT THIS ROLE

Our Health Plan Operations Team ensures that the appropriate infrastructure in place to support our corporate offices, Care Partners and Members and Brokers. The Director, Commercial Claims will collaborate on an end to end basis with cross functional Bright Health Plan departments, vendors and other constituents to manage an accurate, timely, compliant and efficient claims processing experience, and addressing service issues as they arise. 

YOUR RESPONSIBILITIES

• Lead the development of Bright Health Plan Claims core competency both in terms of internal execution and necessary oversight and collaboration with applicable vendors
• Implement and monitor business policies consistent with regulatory requirements
• Develop the appropriate requirements for performance monitoring and reporting at market corporate level, monitoring includes oversight of service level contractual requirements, end to end key performance indicators impacting timely, accurate and cost-effective claims payment
• Implement effective quality control and audit programs along with necessary reporting that verifies transactional accuracy and identifies error trends, defects and process improvement opportunities
• Partner with Configuration and Fee Schedule build team as needed to improve auto adjudication rate and claim turnaround time
• Create and distribute necessary daily/weekly/monthly operational reporting in manner that provides the wider organization key day and insight as to the state of claim operations

SUPERVISORY RESPONSIBILITIES

• This position has supervisory responsibilities for Commercial Claim team

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Bachelor’s Degree or 15+ year healthcare operations (claims, revenue cycle experience).
• 10+years leadership in a healthcare revenue cycle/claim payment setting

PROFESSIONAL COMPETENCIES

• You are very detail oriented
• You thrive in fast-paced environments and excel at creating structure and bringing operational rigor to teams
• You have a passion for creating an effective team environment and resolving conflicts
• You are self-directed and do a great job of prioritizing
• Like others on our team, you are humble, mature and check your ego at the door
• You are brave and always challenge the status quo but respectful and have an open mind
• You are excited to take ownership at early stage of company

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!