Sr Quality Assurance Auditor

Bright Health Group

Remote
  • Job Type: Full-Time
  • Function: Engineering QA
  • Industry: Health Care
  • Post Date: 09/22/2022
  • Website: brighthealthgroup.com
  • Company Address: 8000 Norman Center Dr, Suite 1200, Bloomington, Minnesota 55437, US

About Bright Health Group

Bright Health Group delivers a smarter, more connected healthcare experience. The company’s exclusive partnerships with leading health systems, affordable health insurance plans, and simple, friendly approach to technology are reshaping how people and physicians achieve better health together.

Job Description

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.

SCOPE OF ROLE

The Quality Assurance Analyst II is responsible for the timely and accurate review of various tasks performed by Operations (including, but not limited to, claims processing, call handling and member/provider data maintenance). Identifies system and/or operational issues hindering the attainment of quality performance standards as defined by Bright Healthcare’s policies and associated business rules. Provides issue identification, problem analysis and strategies for resolution and/or implementation to the Leadership team. Participates in problem solving and alignment initiatives.

ROLE RESPONSIBILITIES

The Quality Assurance Analyst II job description is intended to point out major responsibilities within the role, but it is not limited to these items.

  • Utilize knowledge of State-based exchange, Federal Facilitated Marketplace (FFM) and Bright Health procedures to accurately conduct quality inspections of transactions (phone, chat, email, workstreams, etc.); Maintains knowledge of current processes to determine alignment with defined processes and procedures across multiple process areas/workstreams; Accurately report results in the Quality system; Recognizes and recommends areas needing improvement.
  • Participate in the Internal/External calibration and alignment workflows and Operations working sessions for each workstream.  Where there is variation across workstreams, BPOs and business partners, co-facilitate discovery sessions to identify the root cause(s); Works with Quality Leadership to continually define/refine Quality Assurance guidelines and standards.
  • Identifies delivery gaps; Provides actionable data and recommendations to management and training team that will improve business outcomes.  Prepare presentations. Participate in CAP discussions
  • Assist Quality Manager in extracting and compiling information from the quality management system. Compile reports and identify trends for management on an ongoing basis.
  • As needed, perform or assist with any other tasks, programs, initiatives, or assessments as assigned (including Train/Cross-training Quality inspection staff members on quality and operations procedures).

SUPERVISORY RESPONSIBILITIES

This position does not have supervisory responsibilities

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

  • 3 years’ experience including a minimum of 1 year related experience in a quality audit capacity (preferably in healthcare or insurance sector) with consistent above target performance; working knowledge of insurance industry and medical terminology; detailed knowledge of relevant systems and proven understanding of processing principles, techniques and guideline
  • Demonstrated ability to manage multiple projects and excellent organization skills.
  • Demonstrated ability to prioritize work, to act and work independently, and to report items as defined by Quality Management procedures.
  • Excellent verbal and written communication skills, with the ability to share vision, direction, and data with colleagues across all levels and in a wide range of different work groups.
  • Show strong negotiation skills and diplomacy in communication with internal customers.

PROFESSIONAL COMPETENCIES

  • Must be detailed oriented and present critical analytical thinking skills
  • Must have advanced attention to detail for reviewing and detecting discrepancies
  • Ability to prioritize and handle multiple tasks effectively, remain flexible, and adapt to shifting work demands.
  • Collaborate effectively with internal and external partners to resolve issues for our members and providers.
  • Must present strong ability to read and comprehend material presented both orally and in writing
  • Ability to read, understand and apply program operations manual
  • Strong communication skills, both verbal and written
  • Works independently with little supervision
  • Able to thrive and adapt in a fast paced; Must be flexible to change and open to learning new tasks as assigned
  • Must have knowledge of and experience using computer technology, including Microsoft office software including word and excel.
 

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.

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