ABOUT THE ROLE

The Claims Program Manager, Transformation Management is responsible for leading, managing and successfully executing the installation, implementation and migration of systems and processes specific to the assigned functional domain.

YOUR RESPONSIBILITIES

• Functional Domain Program Management:
• Identifies and works with business SMEs at Bright Health to identify, understand, and translate business rules, processes, and business objectives to inform direction of transformation initiatives
• Detailed understanding of current state functions, future state goals and translation between core and non-core systems
• Fields requests from external teams and other Transformation Office teams to obtain detailed business information and secure commitments from SMEs on response times
• Creates and/or explains templates and tools used to collaborate with other teams
• Collaborates with business SMEs to set expectations of time commitments both in terms of level of effort and timing to minimize disruption to business-as-usual activities
• Drives accountability with the business SMEs to provide inputs and sign-off on requirements, design, and acceptance criteria for implementations and migrations
• Escalates risks and issues to Transformation Office Leadership
• Partners with other Functional SME Leads within their team to drive cross-function solutioning
• Collaborates with other Functional SME Leads within the team to coordinate joint sessions between functions needed to drive requirements gathering and sign-off activities
• Works with Functional SME Leads in other Transformation Office teams when cross Line of Business solutioning and sign-off is required
• Migration planning for current year and overall transformation plan from a people, process, and technology standpoint
• Able to serve as a liaison between both business and technical teams to drive effective, timely solutions that fulfill both strategic and operational needs
• Process Improvement:
• Completes other assignments and initiative-based projects balancing company need, individual skill-set, and individual desire
• Maintains HIPAA guidelines to ensure the confidentiality of all calls and documents

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Strong working knowledge of Medicare and CMS Submissions required
• Strong NCQA experience preferred
• Strong knowledge and experience of end-to-end claims lifecycle management including claims inbound, Edits, COBs, claims adjustments, episodes, etc., required
• Strong experience with the following domain components: benefits and pricing configuration, provider data management, claims workflows, accumulators, encounters, and payment integrity, required
• Has knowledge of claims regulatory requirements and penalties relevant to lines of business, preferred
• Bachelor’s degree preferred; Three (3) to Five (5) years of equivalent experience will be considered in lieu of degree
• Three (3) or more years of healthcare experience required
• Three (3) years or more of experience managing projects with demonstrated success required
• Three (3) years or more of experience in a management/leadership role with demonstrated success required
• Knowledge of business processes to inform system migrations preferred

PROFESSIONAL COMPETENCIES

• Self-motivated
• Thrives in a results-driven environment
• Proficient with Microsoft Office Suite (Word, Excel, Power Point)
• Proficient with Project Management tools
• Effectively manage and balance priorities for self and team
• Professional who properly handles confidential information
• Ability to work well independently and in a team environment
• Excellent written and verbal communication skills
• Ability to positively handle/manage stress, such as high work volume and frequent change
• Proven ability to think outside the box, optimize cross-functional processes and lead change
• A blend of big-company business and process management experience, with the ability to translate needs to entrepreneurial/startup organizations
• Outstanding client relationship, client facing and consulting skills. Able to juggle multiple priorities and know when to delegate, and when to take direct ownership
• Comfortable presenting to senior executives
• Ability to excel at communicating a variety of messages to varying audiences
• Ability to build relationships effortlessly and can follow through and get results

LICENSURES AND CERTIFICATIONS

• PMP Certification preferred
• PAHM Certification preferred

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!