Brighton Health Plan Solutions, LLC

Eligibility Service Representative - Spanish

Brighton Health Plan Solutions, LLC · Full Time · 3 hours ago

Brighton Health Plan Solutions, LLC

🌎 United States 💵 $43000 - $50000 per year ⭐ 2-5 yrs exp 💼 Support

The Eligibility Service Representative will manage caregiver inquiries and resolve issues related to eligibility, benefits, and premium billing. They will also perform call center functions and collaborate with internal teams to ensure timely and accurate resolution of customer requests.

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Eligibility Service Representative - Korean

Brighton Health Plan Solutions, LLC · Full Time · 3 hours ago

Brighton Health Plan Solutions, LLC

🌎 United States 💵 $43000 - $50000 per year ⭐ 2-5 yrs exp 💼 Support

The Eligibility Service Representative will manage caregiver inquiries and resolve eligibility, hours, or premium issues through various communication channels. They are responsible for conducting research, maintaining client requirements, and collaborating with internal teams to ensure high-quality service delivery.

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Eligibility Service Representative - Mandarin/Cantonese

Brighton Health Plan Solutions, LLC · Full Time · 3 hours ago

Brighton Health Plan Solutions, LLC

🌎 United States 💵 $43000 - $50000 per year ⭐ 2-5 yrs exp 💼 Support

The Eligibility Service Representative will manage caregiver inquiries and resolve issues related to eligibility, benefits, and premium billing. They will also conduct outreach to internal partners and maintain accurate records while ensuring high-quality customer service across multiple communication channels.

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Eligibility Service Representative - Russian Speaking

Brighton Health Plan Solutions, LLC · Full Time · 7 hours ago

Brighton Health Plan Solutions, LLC

🌎 United States 💵 $43000 - $50000 per year ⭐ 2-5 yrs exp 💼 Support

The Eligibility Service Representative is responsible for resolving caregiver inquiries regarding eligibility, benefits, and enrollment issues. They will manage requests through multiple channels while ensuring high-quality service and timely resolution of complex problems.

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Senior Manager, Medical and Clinical Claim Policy and Integration

Brighton Health Plan Solutions, LLC · Full Time · 11 days ago

Brighton Health Plan Solutions, LLC

🌎 United States ⭐ 5-10 yrs exp 💼 Software Development

The Senior Manager is responsible for developing, updating, and managing medical and clinical claim policies to optimize utilization and cost. They collaborate with cross-functional teams to implement these policies, manage system configurations, and ensure compliance with regulatory requirements.

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Utilization Management Nurse

Brighton Health Plan Solutions, LLC · Full Time · a month ago

Brighton Health Plan Solutions, LLC

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

Perform clinical utilization reviews and medical necessity determinations using evidence-based guidelines and national standards. Collaborate with healthcare partners and prepare cases for Medical Director oversight to ensure timely care delivery.

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Enrollment and Eligibility Specialist

Brighton Health Plan Solutions, LLC · Full Time · a month ago

Brighton Health Plan Solutions, LLC

🌎 United States ⭐ 2-5 yrs exp 💼 Others

Responsible for creating, auditing, and updating member enrollment profiles while ensuring participants are placed in correct health plans. The role involves troubleshooting eligibility inquiries and collaborating with finance and employer partners to resolve premium issues.

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Casualty Bill Review Specialist

Brighton Health Plan Solutions, LLC · Full Time · 2 months ago

Brighton Health Plan Solutions, LLC

🌎 United States ⭐ 5-10 yrs exp 💼 Others

The specialist ensures accurate and compliant medical bill review within the New York workers' compensation and casualty environment. They serve as a subject matter expert to configure bill review rules, workflows, and pricing while training interdepartmental staff.

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Vice President, Contribution Accounting & Enrollment Eligibility

Brighton Health Plan Solutions, LLC · Full Time · 2 months ago

Brighton Health Plan Solutions, LLC

🌎 United States ⭐ 10+ yrs exp 💼 Finance

Lead the strategic direction and operational oversight of contribution accounting and enrollment eligibility for multi-employer health and welfare funds. Ensure accurate processing of employer hours files and contributions while driving process automation and maintaining strong client relationships.

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Senior Data Analyst, Clinical Programs

Brighton Health Plan Solutions, LLC · Full Time · 3 months ago

Brighton Health Plan Solutions, LLC

🌎 United States ⭐ 5-10 yrs exp 💼 Software Development

The role involves developing KPIs, statistical models, and predictive analytics to monitor clinical program performance and member outcomes. The analyst will create client-facing dashboards and provide actionable insights to inform healthcare strategy and ROI.

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