brightonhealthplansolutions
Care Coordinator
About The RoleMagnaCare provides Utilization Review/ Case Management/ Medical Management/Claims Review services to its clients. Care Coordinators facilitate care management and utilization review by performing data collection & data entry, and effectively communicating with Nurse Case Reviewers/Mana
Vice President, Enterprise Infrastructure, Cloud Transformation
About The RoleThe Vice President of Enterprise Infrastructure, Cloud Transformation is a senior technology executive who leads the enterprise infrastructure strategy, cloud migration roadmap, infrastructure modernization, operational resilience, cybersecurity oversight, and enterprise technology ris
Vice President, Enterprise Infrastructure, Cloud Transformation
Customer Service Specialist- Onsite P/T
About The RoleBrighton Health Plan Solutions seek a detail-oriented and empathetic North Carolina-based Customer Service Specialist to join our team. In this part-time role, you will provide in-person support to our members at an assigned service center location. You will assist customers with membe
Programmer Analyst
About The RoleWe are looking for a motivated and energetic Programmer Analyst who possesses a basic understanding of the software development lifecycle, working knowledge of SQL and database concepts, and familiarity with AI technologies, including the use of agents to assist with code prototyping a
Account Executive -Workers Compensation
About The RoleBrighton Health Plan Solutions is seeking an experienced Account Executive with deep expertise in medical payments for workers’ compensation and automobile insurance claims, PPO network strategies, and bill review organizations. This role is primarily focused on client retention, relat
Casualty Account Executive
About The RoleBrighton Health Plan Solutions is seeking an experienced Account Executive with deep expertise in medical payments for workers’ compensation and automobile insurance claims, PPO network strategies, and bill review organizations. This role is primarily focused on client retention, relat
Customer Service Representative
About The Role The Customer Service Representative assists members, physicians, hospitals, revenue agencies and other healthcare providers with member benefits, eligibility, claims inquiry, claim reconsiderations and appeals. The Customer Service Representatives must be able to work in various shift
Customer Service Representative/ Bilingual (Spanish)
About The RoleThe Customer Service Representative, Bilingual, assists members, physicians, hospitals, revenue agencies and other healthcare providers with member benefits, eligibility, claims inquiry, claim reconsiderations and appeals. The Customer Service Representatives must be able to work in va
Customer Service Representative/ Bilingual (Spanish)
Eligibility Service Representative - Korean
About the Role Brighton Health Plan Solutions (BHPS) is seeking an Eligibility Service Representative (ESR) who are experienced in understanding eligibility, communicating through various multi-channel features such as phone, chat and email, and following workflows to assist in issue resolution. BHP
Eligibility Service Representative - Spanish
About the Role Brighton Health Plan Solutions (BHPS) is seeking an Eligibility Service Representative (ESR) who are experienced in understanding eligibility, communicating through various multi-channel features such as phone, chat and email, and following workflows to assist in issue resolution. BHP
Eligibility Service Representative - Mandarin/Cantonese
About the Role Brighton Health Plan Solutions (BHPS) is seeking an Eligibility Service Representative (ESR) who are experienced in understanding eligibility, communicating through various multi-channel features such as phone, chat and email, and following workflows to assist in issue resolution. BHP
Eligibility Service Representative - Russian Speaking
About the Role Brighton Health Plan Solutions (BHPS) is seeking an Eligibility Service Representative (ESR) who are experienced in understanding eligibility, communicating through various multi-channel features such as phone, chat and email, and following workflows to assist in issue resolution. BHP
Senior Manager, Medical and Clinical Claim Policy and Integration
About The RoleThe Senior Manager of Medical and Clinical Claim Policy and Configuration is a senior level decision maker responsible for the content and management of Medical and Claim Policies. Also provides direction and support for system configurations as well as necessary operational assistance
High Dollar Review Specialist
About the Role Brighton Health Plan Solutions is seeking a High Dollar Specialist to review high dollar claims for appropriate and accurate billing, pricing and adjudication. This individual will play a key in the Quality Department and interact with many internal and external stakeholders.* This is
Enrollment and Eligibility Specialist
About The RoleBrighton Health Plan Solutions is seeking an experienced Specialist for our Enrollment and Eligibility/ Employer Services Department to work remotely. We are a hybrid unit, a balance of a contact center and processing department. The Enrollment and Eligibility Team’s (EET) mission is t
Casualty Bill Review Specialist
About The RoleThe Casualty Bill Review Specialist is responsible for ensuring accurate, compliant, and efficient medical bill review within the New York workers’ compensation and casualty environment. This role serves as a subject matter expert (SME) in New York and other state regulations, partneri
Supervisor, Customer Service
About The RoleBHPS is seeking an experienced Customer Service Supervisor to manage the company’s service operations for members and providers and high traffic call center. The Supervisor directly manages the daily performance an activities of the Customer and/or Provider Service call center represen
Contract Manager
About The RoleBHPS is seeking a Contract Manager responsible for the contracting and maintenance of the relationship with network health systems in their assigned territory or specialty. This also includes the recruitment, and management of the provider network inclusive of hospitals and physician g
Senior Data Analyst, Clinical Programs
About The RoleThe Senior Data Analyst, Clinical Programs will be an analytically driven team player, responsible for understanding business needs and objectives, eliciting requirements from stakeholders, and analyzing data and processes to identify opportunities for improvement. This role will suppo
Account Executive
About The RoleBrighton Health Plan Solutions is seeking an experienced Account Executive with deep expertise in commercial, self-insured employer benefit plans with 1000+ subscribers, PPO network strategies, and Third-Party Administration (TPA) organizations. This role is primarily focused on client