SCOPE OF ROLE

The Director, Claims Administration will collaborate on an end-to-end basis with cross functional Bright Health Plan departments, vendors and other constituents to manage an accurate, timely, compliant and efficient claims processing experience, and addressing service issues as they arise.

ROLE RESPONSIBILITIES

The Director, Claims Administration job description is intended to point out major responsibilities within the role, but it is not limited to these items.

• Develop the appropriate requirements for performance monitoring and reporting at market corporate level.  Monitoring includes oversight of service level contractual requirements, end to end key performance indicators impacting timely, accurate and cost-effective claims payment.
• Lead the development of Bright Health Plan Claims core competency both in terms of internal execution and necessary oversight and collaboration with applicable vendors.
• Implement and monitor business policies consistent with regulatory requirements.
• Implement effective quality control and audit programs along with necessary reporting that verifies transactional accuracy and identifies error trends, defects and process improvement opportunities.
• Partner with Configuration and Fee Schedule build team as needed to improve auto adjudication rate and claim turnaround time.
• Create and distribute necessary daily/weekly/monthly operational reporting in manner that provides the wider organization key day and insight as to the state of claim operations.

SUPERVISORY RESPONSIBILITIES

• This position has supervisory responsibilities within Claims Administration team.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Bachelor’s Degree or fifteen (15) years healthcare operations (claims, vendor management) required
• Ten (10) years of experience in a healthcare claim payment setting.
• Three (3) years of experience of management experience

PROFESSIONAL COMPETENCIES

• Detail oriented.
• Thrive in fast-paced environments and excel at creating structure
• Bring operational rigor to teams.
• Self-directed and do a great job of prioritizing
• Ability to convey vision and create buy-in in simple and concise manner to executive leadership 

LICENSURES AND CERTIFICATIONS

• No licensures and/or certifications are required for this role.

WORK ENVIRONMENT

• 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.