MISSION, VISION AND VALUES
“Making Healthcare Right. Together.” is the cornerstone of all we do. Our vision is to deliver the best healthcare experience by putting brilliant minds, empathetic hearts and personalized technology to work to create meaningful relationships between our members and Care Partners. To successfully achieve our mission and vision as we operate in a dynamic health care environment, we expect Bright People to embody and uphold our core values in work and interactions, both internal and external: Be Purposeful, Be Authentic, Be Brave, Be Positive and Be Respectful.
SCOPE OF ROLE
The Senior Operations Analyst will support Medicare claims system configuration and report into the Sr. Manager of Administrative Operations for Execution and Monitoring. This individual will work closely with his/her manager, other Operations leaders and plan leadership to define, manage and test configuration solutions required to appropriately administer Bright’s Medicare benefits. The Senior Operations Analyst will also work closely with Bright’s claims vendor, overseeing services related to issue management, system capability assessment and ongoing maintenance.
The Senior Operations Analyst job description is intended to point out major responsibilities within the role, but it is not limited to these items.
1. Develop, load, edit, and maintain system configuration items
2. Perform, and anticipate, needed analytical and technical support for defining, tracking, and resolving system issues, changes, and enhancements
3. Identify configuration enhancements that promote ongoing efficiency and accuracy for future benefit builds
4. Develop and maintain technical configuration documentation, including policies and procedures
5. Develop test cases based on business requirements, and maintain test data in alignment with approved test cases
6. Perform actual system testing, validating and analyzing results
7. Inform efforts contributing to continuous process improvement of the overall testing and QA process for the claim system
8. Participate in projects for the implementation of system releases, changes and upgrades
9. Maintain an understanding of the various applications and tools used throughout the enrollment, billing and claims processes
10. Trains and supports users to ensure they are using the applicable systems correctly
11. Assist and support audit activities performed by various entities (operational and/or regulatory audits)
12. Present routine updates on your work to Bright leadership
13. Participate within vendor oversight activities and related governance strategy
14. Manage workplans and prioritize resources to meet key deliverables
15. Keep current with industry trends (business and technical) to help derive configuration standards
16. Other duties and responsibilities as assigned
This position does not have supervisory responsibilities.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
· At least 3 years of experience, working with the QNXT system and 2 years of experience with EAM
· At least 5 years of experience associated with claims processing systems, with a specific focus on the configuration of benefits, fee schedules, service codes, utilization management edits, provider contracts and enrollment activities
· At least 2 years of experience associated with the enrollment and claims systems for Medicare Advantage plans
· Must have a working knowledge of how benefits, rates, fee schedules, and provider contracts impact the payment and processing of claims
· Prior experience implementing and testing system enhancements, including the development of test cases and maintaining test data
· Basic SQL knowledge required
· Takes a creative approach to audience-facing reporting and documentation, establishing templates for use by others as needed
· Strong operational mindset and use data to draw insights; when applicable data is not available, you have the ability to gather all available information to support an approach and devise steps to measure the impact of your work for future iterations
· You incorporate datasets into a way that is usable by others with a simple interface
· Comfort with creating and managing timeline driven workplans, as well as creating process flow documentation that supports your work
· Ability to thrive and drive results in a collaborative environment
BEHAVIORAL AND LEADERSHIP NORMS
· Bright Values: Lives the Bright Values. Is focused on bravery needed to develop a variety skills. Not afraid to ask questions or take risks. Focuses on purposeful planning and objective setting. Focuses on the team’s successes, and how to support that effort.
· Collaboration: Is an effective collaborator that works well with the functional team and others in the organization to align on timelines and effective delivery of a project or task. Is solution oriented and works on generating input from multiple constituents and driving the team to a solution. Is able to work with different personality types and teammates to overcome differences in opinion and thought to achieve common company goals.
· Delivers Results: Is results oriented. Focuses on results and the best and most efficient avenue for achieving results. Works with manager or appropriate liaison in the organization to work through goal setting and milestone development to ensure timely and high quality work product. Achieves strong results within functional area. Is focused on managing against a predetermined set of objectives, and creates and follows process. Delivers outstanding and sustained results.
· Exhibits Curiosity: Focuses on learning about the business at large. Seeks to understand how they can drive the business forward and how the bigger picture works. Actively participates in his/her own career development.
· Multi-tasking: Balances multiple projects and initiatives at any given time. Alongside manager or appropriate Bright teammate, re-evaluates priorities based on changing company needs to understand what must be done today. Able to balance multiple projects and initiatives at any given time. Capable of deciphering which priorities are most important for the function/organization. Consistently meets deadlines.
· Training and Mentoring: Helps train and mentor others: Actively participates in the onboarding and ongoing success of teammates. Onboards, trains and provides informal mentorship to new and existing teammates (interns, consultants, etc.). Provides thoughtful solutions, direction and advice to others, and help advise on priorities.
· Upward Management: While balancing multiple initiatives, successfully manages expectations with appropriate project owner about capacity, challenges and barriers to success. Is not afraid to ask for help, guidance or feedback.
LICENSURES AND CERTIFICATIONS
· No licensures and/or certifications are required for this role.
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. Some travel may be required.