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About The Role

Provide the support necessary to grow, build and maintain the relationship between Casualty customers and network providers.  Provide education and issue resolutions to MagnaCare network providers and customers, for the Workers’ Compensation and No-Fault lines of business. Work closely with both providers and customers, when there is a dispute raised by a network provider or customer.  Maintain comprehensive knowledge of provider and company specific policies and procedures.  Partner with Provider Contracting, Sales, Medical Management and Operations Department in identifying and resolving provider issues. The Support Specialist reports to the Supervisor of Casualty Support.

The successful candidate will be afforded an opportunity to help further structure this team. This team is a critical component to the delivery of quality healthcare services.

Primary Responsibilities

+ Educate providers on current policies, trends and information affecting their participation within the MagnaCare network

+ Act as liaison for interpretation of No-Fault and Workers Comp contracts

+ Respond to inquiries specifically related to the provider’s contract or claim issue

+ Research provider contract/claim issues received by the provider or the client, and perform claims analysis

+ Maintain database for provider issues and create detailed reports as needed

+ Assist with the Casualty enrollment process when required

+ Negotiate solutions and resolve conflicts in a manner that will ensure client/provider satisfaction

+ Maintain provider network by negotiating/retaining key providers

+ Surface issues and work with interdepartmental representatives to establish plans for resolution

+ Coordinate efforts with members of the management team in developing short- and long-term plans that result in high performance provider services

+ Assist in the development and update of provider panels

+ Provide back-up support to other Casualty teams, including Care Coordination

+ Assist with Provider and/or Customer Implementations as needed

Essential Qualifications

+ Superior oral and written communication skills

+ Strong PC skills (excel is a must)

+ Knowledge of the health insurance industry, products and services

+ Familiarity with claims and claims processing.

+ NYS WC claim processing a plus

+ Strong follow-up, negotiating and influencing skills

+ Excellent problem-solving skills

+ Capable of managing multiple complex issues

+ Ability to maintain a professional demeanor under pressure

+ Work well independently and as a team player

+ Minimum of two years’ experience

+ Bachelor's degree or equivalent experience

About

At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion, and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all your unique abilities.

Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes, and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions. Come be a part of the Brightest Ideas in Healthcare™.

Company Mission

Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.

Company Vision

Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.

DEI Purpose Statement

At BHPS, we encourage all team members to bring your authentic selves to work with all your unique abilities.   We respect how you experience the world and welcome you to bring the fullness of your lived experience into the workplace.  We are building, nurturing, and embracing a culture focused on increasing diversity, inclusion and a sense of belonging at every level.

*We are an Equal Opportunity Employer

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