About the Role

Brighton Health Plan Solution (BHPS) is seeking a highly motivated candidate to manage departmental and client specific escalations for all service departments within BHPS.  The successful candidate will have strong issue resolution skills as well as analytical and personal skills. They will be able to adapt to high pressure situations, tight deadlines, and be extremely detailed orientated. Strong technical skills including Microsoft Excel, PowerPoint and Word.

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.

Primary Responsibilities

• Receives, tracks and responds to all call center escalation issues.
• Reviews client event report notes to identify service trends, high volume callers, and service issues that may be open to facilitate closure.
• With little to no script guidance, the Escalation Specialist will have to use appropriate verbiage and level of detail to formulate and adapt the response to the level of understanding the caller has about the Brighton Health Plan Solutions/MagnaCare processes and specific plan details.
• Coordinates with partnering departments to find the answers to all open issues and sees them through to closure while keeping in regular communication with all parties involved.
• Works with leadership team to review low post call survey scores to identify gaps in service delivery.
• Clarify customer requirements; probe for and confirm understanding of requirements or problem.
• Contribute trending observations from resolved escalations to develop more effective methods of service delivery. 
• Must have demonstrated ability to meet or exceed departmental attendance, productivity standards and quality standards outlined in a high-volume customer service position with continuous interaction with subscribers and customers. 
• Must have advanced writing skills with the ability to clearly communicate to the customer without the need for supervision.
• Must make effective decisions that balances the interests of the company and the customer.
• Must be able to accurately identify root cause for complex problems, recommend and apply appropriate interventions to avoid future occurrence.
• Creatively approach problems in new and different ways that lead to innovative solutions.
• Anticipates what customers are feeling and thinking and can proactively address concerns, avoiding development of a negative situation or escalation.
• Must be able to cope well with the ongoing demands of change; sees and shows others the benefits of change.
• Makes oneself available to others to help solve technical or procedural problems or issues.

Essential Qualifications

The successful candidate will have experience in a high-volume call center, experience with claims inquiry and claims review procedures, knowledge of medical specialties, fee schedules, complaints and appeals and call center responsibilities. Previous experience in a physician’s office, group practice, clinic or hospital-based practices.

• High School diploma.
• Experience handling escalated customer concerns is preferred.
• Some college or business school education is a plus.
• Effective verbal and written communication skills
• Fluency in Impact, Medical Management and MyCreate portal navigation.
• Intermediate knowledge of Microsoft Office including Word, Excel, PowerPoint and Outlook.
• Strong time management skills.
• Knowledge of CPT codes, ICD-10. 
• Knowledge of care procedures, claims payment policies.
• Courteous with strong customer service orientation.
• Dependable with proficient attention to detail.
• Solid problem-solving skills.
• Previous multi-channel experience (i.e., voice, email, and chat) a plus.

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 of 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 Employee

JOB ALERT FRAUD:  We have become aware of scams from individuals, organizations, and internet sites claiming to represent Brighton Health Plan Solutions in recruitment activities in return for disclosing financial information.  Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All of our career opportunities are regularly published and updated brighonthps.com Careers section.  If you have already provided your personal information, please report it to your local authorities. Any fraudulent activity should be reported to: [email protected]