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Job Details

Vice President, Health Plan Administration at Bright Health
Minneapolis, MN, US
ABOUT US
 
Bright Health is delivering a smarter, more connected healthcare experience. Our affordable health insurance plans and exclusive partnerships with leading health systems are reshaping how people and physicians achieve better health. Today, Bright Health provides health insurance to individuals in Colorado, Arizona, and Alabama in both the Individual and Medicare Advantage space. In 2019, we will expand our reach to include Tennessee, New York and Ohio.
 
Our mission? Making Healthcare Right. Together.
 
ABOUT YOU
As the Vice President of Health Plan Administration, you will provide leadership over our Health Plan Administration functions. You will lead a cross functional team focused on claims, enrollment, billing, reporting, constituent services, and project management. You will drive operational success of our existing health plans, and will ensure successful launch and operations for new products and markets.

YOUR RESPONSIBILITIES:

    • Responsible for the strategic and tactical oversight of the Underwriting, Enrollment, ID Card Fulfillment, Premium Billing, Claims and EOB Fulfillment, Member & Provider Service, and Complaints & Appeal functions in multiple markets and market segments at Bright Health
    • Lead and manage the Project Management Organization and oversee operational management infrastructure, and process and standard performance reporting
    • Ensure the right balance of quantitative and qualitative goals are met leading to maximized customer satisfaction
    • 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
    • Partner with senior leaders in the organization to drive cross-departmental efficiency and continuous process improvement beginning in the design phase
    • Operationalize innovative benefits, programs, networks, provider contracts, and medical cost-reduction strategies
    • Ensure the operational success of existing markets and products
    • Oversee 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

REQUIREMENTS:

    • 10-15 years of experience in a leadership position within the health plan administration function
    • 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
    • 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
    • Excellent planning and execution capabilities
    • Success managing multiple initiatives and priorities simultaneously
    • Ability to quantify impact and ROI of initiatives
    • Strong analytical skills; ability to synthesize information and report on trends
    • Effective at working independently and in collaborative group efforts
    • Strong skills in listening, oral, and written communications
    • Creative problem solving and strong influencing skills
    • Empathetic to the consumer and focused on delivering a superior member experience