VP, Health Plan Operations at Bright Health
- 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
- 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.