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Basis of Presentation, Summary of Significant Accounting Policies and Change in Accounting Principle - Restricted Cash and Restricted Investments (Details) - USD ($)
$ in Thousands
Dec. 31, 2020
Dec. 31, 2019
Dec. 31, 2018
Dec. 31, 2017
Restricted Cash and Cash Equivalents Items [Line Items]        
Total restricted cash and restricted investments $ 21,707 $ 28,340    
Current restricted investments 0 704    
Current restricted cash 14,437 19,376    
Total current restricted cash and restricted investments 14,437 20,080    
Non-current restricted investments 616 113    
Non-current restricted cash 6,654 8,147    
Total non-current restricted cash and restricted investments 7,270 8,260    
Cash and cash equivalents 340,490 101,008    
Restricted cash and restricted investments 21,707 28,340    
Restricted investments included in restricted cash and restricted investments (616) (817)    
Total cash and cash equivalents and restricted cash shown in the consolidated statements of cash flows 361,581 128,531 $ 388,325 $ 295,363
Collateral for letters of credit for facility leases        
Restricted Cash and Cash Equivalents Items [Line Items]        
Total restricted cash and restricted investments 3,510 3,610    
Restricted cash and restricted investments 3,510 3,610    
Collateral with financial institutions        
Restricted Cash and Cash Equivalents Items [Line Items]        
Total restricted cash and restricted investments 4,743 5,742    
Restricted cash and restricted investments 4,743 5,742    
Claims processing services        
Restricted Cash and Cash Equivalents Items [Line Items]        
Total restricted cash and restricted investments 12,127 18,171    
Restricted cash and restricted investments 12,127 18,171    
Other        
Restricted Cash and Cash Equivalents Items [Line Items]        
Total restricted cash and restricted investments 1,327 817    
Restricted cash and restricted investments $ 1,327 817    
Bank time deposits        
Restricted Cash and Cash Equivalents Items [Line Items]        
Total restricted cash and restricted investments   4,700    
Restricted cash and restricted investments   4,700    
Collateral with financial institutions, money market funds        
Restricted Cash and Cash Equivalents Items [Line Items]        
Total restricted cash and restricted investments   1,000    
Restricted cash and restricted investments   $ 1,000