Vice President, ASO Administration at Bright Health

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ABOUT THE ROLE
This executive is responsible for driving overall performance and various operations including:
Claims
Constituent Services
Project Management
Enrollment, Eligibility and Billing
Vendor oversight to include but not limited to, networks, PBM’s, claims management, tele-medicine, UM/DM/CM/CC, stop loss, MGU’s, claims administration platforms and software, ID cards, member communications.
Call center and member experience
Financial forecasting and budgeting for line of business

YOUR RESPONSIBILITIES

  • Responsible for the strategic and tactical oversight of the health plan administrative (Enrollment, ID Card Fulfillment, Premium Billing, Claims administration, EOB Fulfillment, and regulatory reporting), Member & Provider Service, and Complaints & Appeal functions, and Underwriting Administration in all markets, across all self-funded product segments, and product types at Bright Health and affiliates and outsourced partners
  • Ensure the operational success of existing markets and products.
  • Lead and manage the Key Initiative Feasibility and Prioritization process.
  • Ensure the right balance of quantitative and qualitative goals are met leading to optimize constituent satisfaction.
  • Responsible for the successful performance of the network operations functions, including network contract extraction and load, provider roster management, and provider data validation for the self-funded product line
  • Establish and chair payment policy committee; lead payment policy strategy.
  • Ensure appropriate application of medical policy through claims payment as appropriate.
  • Use Voice of the Customer operational data to evaluate, report and improve the administrative functions.
  • Manage vendor relationships and ensure that service-level agreements are consistently met.
  • Establish and execute a strategy for health plan operations that leads to long-term operational efficiency and scalability.
  • Partner with senior leaders in the organization to drive cross-departmental efficiency and continuous process improvement.
  • Operationalize innovative benefits, programs, networks, provider contracts, and medical cost-reduction strategies.
  • Oversee multiple medical cost-reduction strategies.
  • Be responsible for Department of Insurance Complaint review, response and analysis
  • Drive operational effectiveness to ensure quality and accuracy of work outcomes based on regulatory, contractual, URAC and/or company commitments.
  • Lead, develop, recruit and retain a highly efficient and effective team of great talent.
  • Establish a strong emphasis on high-quality, efficient and effective processes related to support operations.
  • Ensure policies, procedures and internal controls are developed and implemented.

SUPERVISORY RESPONSIBILITIES

  • This position has responsibility for supervising some members of the Health Plan Administration team. 

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

  • Bachelor’s degree in Business Administration or related field and/or at least ten (10) years of experience in Self-funded health plan administration to include, Enrollment, Premium Billing, Claims, Member and Provider Service, and Appeals
  • Minimum of five (5) years’ experience with: customer satisfaction accountability; experience managing company-wide process improvement initiatives with defined ROI; experience acting as a project or program manager on major system implementations 

PROFESSIONAL COMPETENCIES

  • Experience in creating an effective team environment, building strong relationships, solving problems and issues, managing 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.
  • Success managing multiple initiatives and priorities simultaneously.
  • Ability to quantify impact and ROI of initiatives.
  • Experience with integrating health plan support services and other elements of operations in high-growth environment.

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
    • 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
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