brightonhealthplansolutions
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. Primary
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
Senior Director, Case Management & Outcomes Performance
About The RoleBrighton Health Plan Solutions (BHPS) is a Third Party Administrator (TPA) serving 400,000+ commercial members across employer-sponsored self-insured plans and proprietary network products, including MagnaCare. The Senior Director, Case Management & Outcomes Performance is a senior cli
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 will be responsible in providing support to our commercial and worker’s compensation self-funded clients seeking cost effective resolution of their member’s claims. Your interest and help leading and developing our team and maturing the program only makes the oppor
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