Jobs and Careers
BR
Director, Application Support and Quality Assurance
Brighton Health Plan SolutionsChapel Hill, United Statesfull_timeVerifiedPosted 18 Apr 2025
About the role
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
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.
- 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.
Apply for this role
Generate a tailored application kit with a matched cover letter, interview prep, and CV highlights — in under 60 seconds.
Apply Now →Generate Application KitFree account required — sign up in 30s