Healthcare Payer Domain Expert

3 days ago


Chapel Hill, North Carolina, United States Brighton Health Plan Solutions, LLC Full time
About Us
Brighton Health Plan Solutions, LLC transforms the health plan experience by bringing outstanding products and services to our partners. We redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.

Job Description
We are seeking a passionate Business Analyst who excels in client interactions, can collaborate effectively with stakeholders to analyze, define, and manage requirements for clients or products. The ideal candidate will have worked in-depth in the healthcare payer domain in Multi-employer Trust (Hours & Eligibility management), Health Plan Administration (Benefits & Claims Administration, Vendor integration) space. This person must possess a blend of business and technical savvy, strong communication skills to collaborate across internal and external stakeholders.

Responsibilities
- Serves as a liaison between the business programs community and the IT organization to provide technical solutions to meet project needs.
- Critically evaluates information gathered from multiple sources; reconciles conflicts; abstracts up from low-level information to a general understanding; and distinguishes requests from underlying true needs.
- Breaks down high-level information into details including sources of data, data types, users, user types, interface components, interface navigation needs, reporting needs, and administrative system needs.

Requirements and Qualifications
- A bachelor's degree (BA Certifications and/or PMP is a plus).
- 4+ years of BA experience in onboarding new self-funded clients or implementing products in the Multi-employer Trust or Health Plan Administration space.
- Good working knowledge of Eligibility and Enrollments, Administration of Plans, Benefits, claims, accumulators, Provider Finder.
- Experience with SFTP, EDI X12 transactions (834, 837, 270/1) is a plus.

Company Overview
Brighton Health Plan Solutions, LLC unlocks opportunities that provide clients with customizable tools to enhance the member experience, improve health outcomes, and achieve their healthcare goals and objectives. We partner with self-insured employers, Taft-Hartley Trusts, health systems, providers, and other TPAs to solve the problems facing today's healthcare.

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