“Making Healthcare Right. Together.” is the cornerstone of all we do. Our vision is through powerful relationships with Care Partners, we help all people live healthy and brighter lives. To successfully achieve our mission and vision as we operate in a dynamic health care environment, we expect Bright employees to embody and uphold our core values in work and interactions, both internal and external: be brave, be brilliant, be accountable, be inclusive, and be collaborative.

The Vice President, Health Plan Operations is responsible for driving overall performance and various operations including, but not limited to:

· Claims

· Constituent Services

· Operational Excellence

· Project Management

· Enrollment, Eligibility and Billing

· Transformational Initiatives

The Vice President, Health Plan Operations job description is intended to point out major responsibilities within the role, but it is not limited to these items.

ROLE 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 product segments, and product types at Bright Health.
• 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.
• 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.
• Execute 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.
• Other duties and responsibilities as assigned.
• This position has responsibility for supervising members of the Health Plan Administration team. 
• 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. 

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Bachelor’s degree in Business Administration, Engineering or related field and/or at least 10 years of experience in Operations, Enrollment, Premium Billing, Claims, Member and Provider Service, and Appeals at a healthcare company
• Minimum of ten (10) years of experience with: Operations, production, manufacturing, engineering, Lean and Six Sigma, 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.
• 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.
• Ability to quantify impact and ROI of initiatives.
• Experience in government programs including Medicare and/or Medicaid.
• 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 Modern Healthcare and Forbes, etc. But more than anything, we're a group of people who are really dedicated to our mission in healthcare. Come join our 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!