Director, Application Support and Quality Assurance
Apply NowCompany: Brighton Health Plan Solutions, LLC
Location: Chapel Hill, NC 27516
Description:
About The Role
The Director of Application Support and Quality Assurance will oversee initiatives that align with the strategic goals of the ASG department. This role includes setting organizational objectives, developing plans, and executing strategies to drive business growth, with a strong emphasis on quality control and improvements to enhance claims processing stability, flexibility, and innovation. The Director will be responsible for both the strategic development and execution of a quality program to ensure continuous improvement and compliance, as well as managing day-to-day activities related to supporting core claims processing system configurations and changes.
Primary Responsibilities
Essential Qualifications
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, you'll 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, you'll be encouraged to bring your authentic self to work with all 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 today's 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 today's challenges into tomorrow's 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 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
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: [email protected]
The Director of Application Support and Quality Assurance will oversee initiatives that align with the strategic goals of the ASG department. This role includes setting organizational objectives, developing plans, and executing strategies to drive business growth, with a strong emphasis on quality control and improvements to enhance claims processing stability, flexibility, and innovation. The Director will be responsible for both the strategic development and execution of a quality program to ensure continuous improvement and compliance, as well as managing day-to-day activities related to supporting core claims processing system configurations and changes.
Primary Responsibilities
- Establishes controls and defines quality program (process and objectives) for end-to-end claims core processing to assure data and processing accuracy. Leads and oversees the QA function, ensuring products and services meet quality standards, developing and implementing QA strategies, and collaborating with cross-functional teams to identify and resolve issues.
- Works within Application support team support to evaluate and add quality controls and process improvements for Core back-Office systems including but not limited to: Core Healthcare Claims Processing Platform including Eligibility & Enrollment (Group, member, product and provider) and core claims processing (pricing, adjudication, edits and payment).
- Actively develops and leads ASG team members in support of QA program to support client configuration and ongoing auditing of system changes. Works with Technical Business Analyst and Programmer Analyst to support day to day activities including, new client implementations, system enhancements and system defects.
- Work with Business community to understand requirements and to assist with providing technical teams solution design to meet business objectives.
- Assists VP, Application Support and other IT VPs along with CIO to establish claims core platform strategic roadmap.
- Establishes processes to audit configuration before deployment to production to streamline timeline and minimize defects. Effectively utilize automated solutions and tools to create greater productivity.
- Develops a key performance quality metrics reporting dashboard and make recommendations for process improvements.
- Creates and documents best practices, standard operation procedures, process flows, functional and technical specifications, process maps for more standardized configuration across clients.
- Collaborate with and support Operations as needed to ensure the efficient processing and optimal performance.
- Supports client implementation and products deployment.
- Works to continuously improve claims system automation and performance.
- Assist VP, Application Support to build a high-performance environment and implement a people strategy that attracts, retains, develops, and motivates their team by fostering an inclusive work environment, using a coaching mindset and behaviors, communicating vision/values/business strategy, and managing succession and development planning for the team.
Essential Qualifications
- Bachelor's degree in technology, Healthcare Admin or related filed with minimum of 7 years' experience in Healthcare Payer or TPA setting.
- Extensive background in understanding claims system configuration including, benefit plans, accumulator exchange and provider contracts. Prior experience with implementing claims systems and QA programs.
- Prior background in implementing and managing Health Care Claims systems transformations and optimizations.
- 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.
- Background in building Quality program, Quality metrics, roadmaps and process improvement.
- Expertise and experience in preparing, Use Cases, Business & Functional specifications, Test strategy & cases and traceability matrix. Experience with automated testing tools a plus.
- Proven ability to map business process and workflows, ensuring requirements are tested and achieved.
- Strong analytical and problem-solving skills; Ability to analyze problems and resolve issues through resolution quickly and methodically.
- 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.
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, you'll 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, you'll be encouraged to bring your authentic self to work with all 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 today's 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 today's challenges into tomorrow's 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 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
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: [email protected]