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.
Bright Health is tripling its footprint in 2019 to offer a variety of health insurance plans to more individuals. Bright Health operates health insurance offerings across Individual and Family Plan segments and the Medicare Advantage space in Alabama, Arizona, Colorado, Ohio, New York and Tennessee.
We’re Making Healthcare Right. Together.
MISSION, VISION AND VALUES
“Making Healthcare Right. Together.” is the cornerstone of all we do. Our vision is to collaborate with Care Partners to make health care simpler, personal and more affordable. 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
This senior leader is responsible for driving overall performance and various operations for the Individual and Family Plan Line of Business, including but not limited to:
· Enrollment, Eligibility and Billing
· Data Reporting & Analytics
The Vice President, Health Plan Administration job description is intended to point out major responsibilities within the role, but it is not limited to these items.
1. Responsible for the strategic and tactical oversight of the health plan administrative (Enrollment, ID Card Fulfillment, Premium Billing, Claims administration, EOB Fulfillment, reporting) for Bright Health’s Individual and Family plans.
2. Ensure the operational success of existing markets and products.
3. Ensure operational readiness for market expansions and new product launches, including development of staffing models and hiring plans to support growth projections.
4. Ensure the right balance of quantitative and qualitative goals are met leading to optimize constituent satisfaction.
5. Ensure appropriate application of medical policy through claims payment as appropriate.
6. Use Voice of the Customer operational data to evaluate, report and improve the administrative functions.
7. Manage vendor relationships and ensure that service-level agreements are consistently met.
8. Partner with senior leaders in the organization to drive cross-departmental efficiency and continuous process improvement.
9. Operationalize innovative benefits, programs, networks, provider contracts, and medical cost-reduction strategies.
10. Drive operational effectiveness to ensure quality and accuracy of work outcomes based on regulatory, contractual, URAC and/or company commitments.
11. Lead, develop, recruit and retain a highly efficient and effective team of great talent.
12. Establish a strong emphasis on high-quality, efficient and effective processes related to support operations.
13. Ensure policies, procedures and internal controls are developed and implemented.
14. Develop and oversee health plan reporting and analytics function, including the creation, management and distribution of operational dashboards and KPI performance.
15. Other duties as assigned.
This position has responsibility for supervising 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 10 years of experience in Enrollment, Premium Billing, Claims, Member and Provider Service, and Appeals at a health insurance company
· Minimum of five 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
· 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 Exchanges, Medicare and/or Medicaid.
· Experience with integrating health plan support services and other elements of operations in high-growth environment.
We've won some fun awards like: Great Places to Work
, Modern Healthcare
, 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.