Hybrid Vendor Performance Lead: Claims & Compliance

BrightonOne; Boston (MA); Hybrid; USD 90,000 - 120,000; Full time

Job summary

BrightonOne is seeking a Senior Specialist, Vendor Performance Management to oversee vendor relationships and monitor performance against SLAs and scorecards. You will partner with technical SMEs to define accountability plans and drive remediation for claims processing.

You will analyze claims data, support configuration validation, and ensure regulatory-compliant vendor performance, reporting to the Director of Vendor Performance Management.

Qualifications

• 4+ years in vendor management, claims operations, or health plan operations.
• Claims operations subject-matter expertise strongly preferred.
• Experience with audits, SLAs, and vendor accountability.
• Strong collaboration with technical SMEs and vendors.

Responsibilities

• Oversee vendor relationships and monitor performance against SLAs and scorecards.
• Define and implement vendor accountability plans and corrective actions.
• Analyze claims performance, identify issues, and drive remediation.
• Prepare governance reporting and maintain audit-ready records.
• Collaborate with operations, compliance, finance, and clinical teams.

Skills

Claims processing

Adjudication

Vendor management

SLA management

Analytical thinking

Stakeholder communication

MS Office

Data accuracy

Time management

Medicare/TRICARE experience

Education

Bachelor's degree or equivalent experience

Tools

Facets

QNXT

HealthRules

MS Office

Job description

BrightonOne is seeking a Senior Specialist, Vendor Performance Management to oversee vendor relationships and monitor performance against SLAs and scorecards. You will partner with technical SMEs to define accountability plans and drive remediation for claims processing.

You will analyze claims data, support configuration validation, and ensure regulatory-compliant vendor performance, reporting to the Director of Vendor Performance Management.