Director, Medicare Advantage Benefits and Contract Configuration at Bright Health

| Remote
Sorry, this job was removed at 6:09 a.m. (CST) on Thursday, September 10, 2020
Find out who's hiring in Austin.
See all Operations jobs in Austin
ABOUT THIS ROLE
Our Operations Team ensures that we have the right infrastructure in place to support our corporate offices, Care Partners and Members and Brokers.
The Director, Medicare Advantage Claims and Configuration, will collaborate on an end to end basis with cross functional BHP departments, vendors and other constituents to support the accurate, timely, compliant and efficient processing of claims along with effective follow up on service issues that impact provider and member satisfaction. Additionally, this position will have oversight over the BMS (claims) and BRC (Configuration) relationships and will be responsible for the accuracy of overall configuration and timeliness of claim payments. 

ROLE RESPONSIBILITIES

  • Lead the develop of Bright’s Medicare Advantage (MAPD) Claims and Configuration core competency both in terms of internal execution and necessary oversight and collaboration with applicable vendors.
  • Develop and maintain business policies consistent with regulatory requirements.
  • Create or when necessary, collaborate with internal and external resources to create process flows, procedures, and materials (including member communications) to support claim administration and configuration.
  • Develop the appropriate requirements for performance monitoring and reporting at market corporate level, both for internal and CMS needs. Monitoring includes oversight of service level contractual requirements, end to end key performance indicators impacting timely, accurate and cost-effective claims payment, CMS performance metrics and defect related statistics.
  • Participate in CMS and other audits. Representing the BHP Claims and Configuration functions. Ensure timely submission of requested documents and data.
  • Collaborate with vendors and internal BHP resources to ensure proper system setup and configuration. Manage the configuration and customization of technology to meet business requirements.
  • Oversee the performance of these functions as performed by internal and delegated teams.
  • Seek ways to achieve continued process improvement to the member and provider experience focusing on quality, timeliness and administrative cost effectiveness. Collaborate with others to create positive points of differentiation pertaining to claims administration.
  • Work effectively on occasional or seasonal projects, either as lead or in collaboration with others that support claims administration or wider BHP objectives.
  • Work with internal resources and vendors to create thorough, cost justified system enhancements that enhance the effectiveness of claims administration.
  • Implement effective quality control and audit programs along with necessary reporting that verifies transaction accuracy and identifies error trends, defects and process improvement opportunities.
  • Create necessary daily/weekly/monthly operational reporting in manner that provides the wider organization key day and insight as to the state of claim operations.
  • Other duties and responsibilities as assigned.

SUPERVISORY RESPONSIBILITIES

  • This position has supervisory responsibility 

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

  • Bachelor’s degree preferred; Ten (10) or more years of related experience required in lieu of a degree
  • Eight (8) or more years of experience in health insurance operations and Medicare Advantage products.
  • Five (5) or more years of experience managing a team
  • QNXT Claims and Configuration experience and knowledge of Cognizant products highly preferred

PROFESSIONAL COMPETENCIES

  • Detail oriented
  • Thrive in fast-paced environments
  • Excel at creating structure and bringing operational rigor to teams
  • Passion for creating an effective team environment and resolving conflicts
  • Self-directed and prioritize well
  • Excited to take ownership at early stage of company

WORK ENVIRONMENT
The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. Travel may be required. 
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!

Read Full Job Description
Apply now
By clicking continue you agree to Built In’s Privacy Policy and Terms of Use.

Technology we use

  • Engineering
  • Product
    • .NETLanguages
    • C#Languages
    • JavascriptLanguages
    • PythonLanguages
    • SqlLanguages
    • PowerShellLanguages
    • D3JSLibraries
    • ReactLibraries
    • Node.jsFrameworks
    • MongoDBDatabases
    • TSQLDatabases
    • 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.

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?

Our team works within an Agile framework with 2 week sprints. Tasks in my sprint that I tackle daily range from ideation, research, designing wires and mocks in Sketch, UI kit updates, prepping for an engineering handoff, etc.

Diane

Digital Product Designer

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

Full Stack Software Engineer

How do you make yourself accessible to the rest of the team?

Modeling after my manager, I like to provide both regularly scheduled one-on-one meetings, where developers and engineers get to set the agenda. We can talk about career development, design and architecture ideas, industry trends, or traditional HR topics like goal setting. It’s up to them. I also have begun setting regular “office hours.”

Amy

VP & Data Platform Architect

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 have an open PTO program. 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
Friends outside of work
Eat lunch together
Daily stand up
Open door policy
Team owned deliverables
Team based strategic planning
Pair programming
Open office floor plan
Diversity
Highly diverse management team
Mean gender pay gap below 10%
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
Onsite Gym
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
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
Employees who have been with the company for 12 months are eligible for 12 weeks of family medical leave.
Company sponsored family events
Bright Health sponsors family oriented events Annually.
Vacation & Time Off Benefits
Unlimited Vacation Policy
Paid Holidays
Perks & Discounts
Casual Dress
Commuter Benefits
Stocked Kitchen
Happy Hours
Happy hours are hosted on occasion.
Fitness Subsidies
Bright Health employees are eligible for discounts on several gym memberships.
Professional Development Benefits
Promote from within
More Jobs at Bright Health24 open jobs
All Jobs
Finance
Data + Analytics
Design + UX
Dev + Engineer
Legal
Operations
Product
Operations
new
Remote
Data + Analytics
new
Remote
Finance
new
Remote
Developer
new
Austin
Data + Analytics
new
Austin
Developer
new
Austin
Design + UX
new
Austin
Data + Analytics
new
Austin
Data + Analytics
new
Austin