Director, Application and Product Engineering

Brighton Health Plan Solutions, LLC is an independent subsidiary of Noble Health, Inc., the investment arm of Blue Cross and Blue Shield of North Carolina.

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