Supervisor, Claims

Company: Bright Health
Location: Diamond Bar
Posted on: January 17, 2023

Job Description:

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Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.

What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.

If you share our passion for changing healthcare so all people can live healthy, brighter lives - apply to join our team.

GENERAL PURPOSE

The Supervisor of claims position will work jointly with leadership to develop, grow and manage the California MA claims department, focusing on the internal audit process and ensuring that internal and external service level agreements are met. In addition, this position has accountability for ensuring that teams comply with all state and federal regulations including those from CMS.

ROLE RESPONSIBILITIES

The Supervisor of Claims job description is intended to point out major responsibilities within the role, but it is not limited to these functions.

• Monitor departmental performance metrics to ensure key performance measures and Service Level Agreements are achieved.
• Appropriately track, work, and report out on claims provider disputes.
• Conduct a Pre-Payment Audit of all high-dollar claims.
• Research and respond to Claim Escalations from Provider Relations, Member Services, and Clinical Operations.
• Facilitate the research and resolution of claims issues arising from Appeals and Grievances, internal audits, and system configuration.
• Collaborate with internal departments to configure plan benefits and facilitate claim testing.
• Review and correct claims data errors.
  SUPERVISORY RESPONSIBILITIES
  
  • This position has supervisory responsibilities for claims daily operational adjudication and other front and back-end responsibilities and ensures proper and sufficient controls are in place, to ensure all compliance guidelines and CMS regulatory processing rules and guidelines.
    EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
    
    • High School diploma or GED required; Bachelor's Degree preferred
    • Three (3) + years of experience in a supervisory capacity
    • Five (5) + years of claims processing experience
      PROFESSIONAL COMPETENCIES
      
      • Comprehensive understanding of all aspects of claims processing
      • Must have strong communication skills (verbal and written)
      • Must be highly organized and be able to prioritize work to meet deadlines
      • Display strong strategic behaviors such as initiative, problem-solving, critical thinking, judgment, innovation, and independence
      • Ability to influence and collaborate with business partners throughout the organization.
        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.
        • Some travel may be required.
          For individuals assigned to a location(s) in California, Bright Health is required by law to include a reasonable estimate of the compensation range for this position. Actual compensation will vary based on the applicant's education, experience, skills, and abilities, as well as internal equity. A reasonable estimate of the range is $67,795.00 to $101,692.00 annually.
          
          Additionally, employees are eligible for health benefits; life and disability benefits, a 401(k) savings plan with match; up to 21 days of PTO, 10 paid holidays, plus 2 floating holidays per year; and a lifestyle spending account.
          
          We're Making Healthcare Right. Together.
          
          We are realizing a completely different healthcare experience where payors, providers, doctors, and patients can all feel connected, aligned and unified on the same team. By eradicating the frictions of competing needs, we are making it possible to give everyone more of what they want and deserve. We do this by:
          
          Focusing on Consumers We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
          
          Building on Alignment We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.
          
          Powered by Technology
          
          We employ our purpose built, integrated data platform to connect clinical, financial, and social data, to deliver exceptional outcomes.
          
          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.

Keywords: Bright Health, Diamond Bar , Supervisor, Claims, Other , Diamond Bar, California