DIRECTOR, APPLICATIONS SUPPORT - HEALTHCARE

About The Role

The Director of Applications Support - HealthCare has responsibility for managing and developing teams to build and enhance the capabilities of Claims, Credentialing and Third Party Integration application in a TPA and / or Payor environment.

The role requires development of quality program for system configuration, changes and enhancements, working in conjunction with the platform vendors including establishing a quality dashboard.

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities and activities may change, or new ones may be assigned at any time with or without notice.

Primary Responsibilities

• Experienced leader with relevant experience in Software Development Life Cycle approach.
• Experience with HealthCare eco-system including configuring and enhancements to Claims Processing Platform and Provider credentialing platform.
• Ability to work with vendors for management of data exchange including but not limited to Eligibility, Pharmacy Benefit Management and other ancillary benefits providers.
• Ability to manage and build upon a high performing team of Business Analysts, Quality Assurance Analysts and Product Specialist responsible for managing applications.
• Ability to effectively communicate across the organization and seek inputs to improve quality.
• Establishes processes to audit configuration before deployment to production to streamline timeline and minimize defects.
• Effectively utilize automated solutions to create greater productivity.
• Develop key performance quality metrics reporting dashboard and make recommendations for process improvements.
• Interacts with internal / external customers to outline information for solution development and monitoring.
• Work with PMO for project timeline, integrates project plans, release schedule and communication.

Essential Qualifications

• Bachelor's degree or equivalent experience. BA Certifications and / or PMP a plus.
• Extensive background in understanding claims system configuration including, benefit plans, accumulator exchange and provider contracts.

Prior experience with implementing claims QA programs.

• Proven results in building and managing a team. Provides direction and guidance to team member. Sets goals for team to achieve and holds team accountable for results.
• Expertise and experience in preparing, Use Cases, Business & Functional specifications, Test strategy & cases and traceability matrix.
• Proven ability to map business process and workflows, ensuring requirements are tested and achieved.
• Excellent verbal / written communication skills; comfortable initiating conversations with both business and technology leaders within the organization, as well as the ability to translate business issues and requirements into technical solutions.
• Strong analytical and problem-solving skills; Ability to analyze problems and resolve issues through resolution quickly and methodically.
• Ability to manage issues, risks and decisions with excellent reasoning judgment
• Excellent verbal and written communication skills.
• Self-motivated and detail-oriented
• Flexibility to adapt to change and willing to learn and develop new skill sets as applicable.
• Proficient with Word, Excel and PowerPoint, Visio
• Knowledge of BA / MS project tools MS Project, Excel, Visio

About

At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered.

When you join our team, youll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level.

Here, youll be encouraged to bring your authentic self to work with all of your unique abilities.

Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing todays healthcare with our flexible and cutting-edge third-party administration services.

Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform.

As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes and achieve their healthcare goals and objectives.

Together with our trusted partners, we are transforming the health plan experience with the promise of turning todays challenges into tomorrows solutions.

Come be a part of the Brightest Ideas in Healthcare.

Company Mission

Transform the health plan experience how health care is accessed and delivered by bringing outstanding products and services to our partners.

Company Vision

Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.

DEI Purpose Statement

At BHPS, we encourage all team members to bring your authentic selves to work with all of your unique abilities. We respect how you experience the world and welcome you to bring the fullness of your lived experience into the workplace.

We are building, nurturing and embracing a culture focused on increasing diversity, inclusion and a sense of belonging at every level.

We are an Equal Opportunity Employer

Annual Salary Range : $140,000 - $170,000

The salary range and / or hourly rate listed is a good faith determination that may be offered to a successful applicant for this position at the time of the posting of an advertisement and may be modified in the future.

When determining a team member's base salary and / or rate, several factors may be considered as applicable by law including but not limited to location, years of relevant experience, education, credentials, skills, budget and internal equity.

JOB ALERT FRAUD : We have become aware of scams from individuals, organizations, and internet sites claiming to represent Brighton Health Plan Solutions in recruitment activities in return for disclosing financial information.

Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants.

All of our career opportunities are regularly published and updated brighonthps.com Careers section. If you have already provided your personal information, please report it to your local authorities.

Any fraudulent activity should be reported to : recruiting@brightonhps.com

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