Casualty Support Specialist

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

💝 Customer Support

👻 Ghost score 12%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Brighton Health Plan Solutions

WebsiteLinkedInAll Job Openings

201 - 500 employees

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

Brighton Health Plan Solutions is a healthcare enablement company transforming the healthcare landscape through innovative technology and customized health plans. With over 30 years of experience in third-party administration, the company specializes in health plan management, direct contracting for employers, and integrated ancillary benefits. Brighton Health Plan Solutions provides advanced technology platforms to simplify administrative tasks and enhance member engagement. They serve as a crucial link in direct contracting between groups and health systems, providing administrative and provider contracting expertise. By aligning stakeholders and creating flexible health plan products, they strive to improve healthcare delivery and outcomes.

📋 Description

• Provide support to grow, build, and maintain relationships between Casualty customers and network providers • Provide education and issue resolution to MagnaCare network providers and customers for Workers’ Compensation and No Fault lines of business • Work closely with providers and customers on disputes raised by either party • Maintain comprehensive knowledge of provider and company-specific policies and procedures • Partner with Provider Contracting, Sales, Medical Management, and Operations to identify and resolve provider issues • Educate providers on current policies, trends, and information affecting network participation • Act as liaison for interpretation of No-Fault and Workers’ Compensation contracts • Respond to inquiries related to provider contracts or claim issues • Research provider contract and claim issues and perform claims analysis • Maintain the provider-issues database and create detailed reports as needed • Log credentialing applications and assist with the Casualty enrollment process • Negotiate solutions and resolve conflicts to ensure client and provider satisfaction • Maintain the provider network by negotiating with and retaining key providers • Surface issues and work with interdepartmental representatives to establish resolution plans • Coordinate with management to develop short- and long-term plans for high-performance provider services • Assist in developing and updating provider panels • Provide backup and support to other Casualty departments, including Care Coordination • Assist with Provider and/or Customer Implementations as needed

🎯 Requirements

• 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 • 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 • Ability to work well independently and as a team player • Minimum of two years’ experience • Bachelor degree or equivalent experience

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