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Monitor Health Plan Compliance: Review and audit of self-funded health plan financial processes to ensure compliance with contractual obligations, regulatory requirements, and internal policies related to the payment of daily healthcare claims and monthly administrative fees. Audit Planning and Exec

At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. 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 pr

The Office of Labor Relations (OLR) represents the Mayor in the conduct of all labor relations between the City of New York and labor unions representing employees of the City. Monitor health plan processes to ensure compliance with contractual obligations, regulatory requirements, and internal poli

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. At Brighton Health Plan

The Office of Labor Relations (OLR) represents the Mayor in the conduct of all labor relations between the City of New York and labor unions representing employees of the City. Job Description The role is responsible for overseeing staff responsible for the reconciling of claims payments within the

The Director of State Product Compliance, reporting to the Vice President of Compliance, plays an integral role in the oversight and management of product regulatory compliance activities, for State products offered by MetroPlus. Bronx, Brooklyn, Manhattan, Queens and Staten Island through a compreh

Lead and execute external audits from regulatory agencies such as NYS Office of State Comptroller (OSC), New York State Office of Medicaid Inspector General (OMIG), Centers for Medicare and Medicaid Services (CMS), New York State Department of Health (DOH), New York State Department of Financial Ser

MetroPlusHealth is seeking a resourceful, creative professional with excellent analytical, project management, and problem-solving skills to serve as Chief of Staff to the Chief Information Officer (CIO) and the Information Technology Department. Proficiency in Microsoft Office - specifically Word,

Coordinate MetroPlusHealth's network development and contracting strategy as MetroPlusHealth expands into new lines of business. Manage an Out-of-Network strategy that addressed high cost out-of-network cases for all lines of business, but primarily for the Commercial and Exchange products. Minimum