brightonhealthplansolutions
Casualty, Support Specialist
About The RoleProvide the support necessary to grow, build and maintain the relationship between Casualty customers and network providers. Provide education and issue resolution to MagnaCare network providers and customers, for the Workers’ Compensation and No Fault lines of business. Work closely w
Behavioral Health, Case Management Nurse
About The RoleBrighton Health Plan Solutions (BHPS) provides Case Management services to its clients. Cases are maintained by Case Managers. The employee reports directly to the Supervisor, Case Management (LCSW). In addition, the role maintains a dotted-line relationship to the Senior Director, Cas
Customer Service Rep, Casualty
About The RoleThe Customer Service Representative assists members, physicians, hospitals, and other healthcare providers with member benefits, eligibility, and appeals. The Customer Service Representatives must be able to work in various shifts Monday to Friday between the hours of 8AM – 5:30PM EST.
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 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 - Mandarin/Cantonese
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 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
Vice President, Contribution Accounting & Enrollment Eligibility
About The RoleThe Contribution Accounting & Enrollment Leader is responsible for the strategic direction, operational oversight, and performance of the Contribution Accounting & Enrollment function within a multi-employer health and welfare fund administration environment. This role ensures the accu
Vice President, Contribution Accounting & Enrollment Eligibility
Medical Director
About The RoleThe Medical Director performs utilization review and medical necessity determinations for BHPS-administered self-funded commercial plans, and supports the Chief Medical Officer in maintaining the quality, consistency, and defensibility of the department’s clinical decisions. Clinical r
Utilization Management Nurse
About The RoleBHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member’s benefit coverage while working remotely.Primary Responsi