Programmer Analyst
Brighton Health Plan Solutions is growing. We have an exciting opportunity for a Programmer Analyst to join our technology team, focusing on benefits and claims process configuration and programming to support our product offerings. In this role, you will play a key part in ensuring the technology behind the full claims adjudication cycle is running smoothly, remains scalable, and is continuously enhanced to meet evolving needs. This is a great chance to contribute to the optimization and growth of critical systems that impact the entire claims process.
Primary Responsibilities
- Collect and analyze requirements to develop effective solution designs.
- Effectively handle the data transformation activities
- Program new provider physician rate builds and manage ongoing rate changes
- Implement new groups eligibility files and manage ongoing eligibility files
- Program new benefit configuration and manage ongoing benefit changes
- Troubleshoot errors during the load process and claims adjudication process communicating the outcome to appropriate stakeholders
- Interact with system vendors to enhance applications with new features and functionality
- Communicate with IT management on the progress of the various initiatives
- Collaborate with IT and non-IT personnel to complete required tasks
Essential Qualifications
- At least 3 years prior experience in Healthcare TPA or insurer environment working with the claims adjudication and ancillary applications
- Familiarity with Healthcare EDI transactions including 800 and 200 series
- Ability to understand complex HealthCare payment rules and design, build and implement system accordingly
- Must possess the ability to manage multiple tasks with minimal supervision
- Communicate effectively with internal and external stakeholders
- Strong attention to detail and perform consistent work product validation/QA
- Strong analytical skills
- Conversant with data integrity principles
- 3+ years of experience with SQL queries that includes but not limited to- ability to extract the data, triaging, update and insert functions
Educational Qualifications
- Undergraduate degree in IT, Healthcare IT and/or progressive experience.
Technical Qualifications
- Familiar with MS Office suite products
- Proficient on Excel and MS Access
- Proficient on MS SQL Server Managed Studio
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, 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 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 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 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
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]