Senior Vendor Performance Specialist (Claims)

BrightonOne; Boston (MA); Hybrid; USD 85,000 - 120,000; Full time

Job summary

BrightonOne, a nonprofit provider of healthcare services, seeks a Senior Specialist for Vendor Performance Management in a hybrid role based in Brighton, MA. You will oversee vendor relationships, define accountability plans with SMEs, and drive improvements in claims processing and compliance.

Responsibilities include monitoring SLAs, conducting operational reviews, and delivering audit-ready reporting while collaborating with operations, compliance, and finance teams.

Qualifications

• Experience managing vendor performance and SLAs across complex programs.
• Subject-matter expertise in claims processing and adjudication preferred.
• Strong analytical, problem-solving, and data-driven decision-making abilities.

Responsibilities

• Oversee vendor relationships and monitor performance against SLAs and scorecards.
• Partner with technical SMEs to define accountability plans and corrective actions.
• Analyze claims accuracy and timeliness to identify root causes and improvement opportunities.
• Prepare vendor performance reporting and maintain audit-ready records.
• Collaborate with operations, compliance, finance, and clinical teams on vendor issues.

Skills

Vendor management

Claims operations

Analytical skills

Communication

Regulatory knowledge

Education

Bachelor's degree preferred

Tools

Facets

QNXT

HealthRules

MS Office

Job description

BrightonOne, a nonprofit provider of healthcare services, seeks a Senior Specialist for Vendor Performance Management in a hybrid role based in Brighton, MA. You will oversee vendor relationships, define accountability plans with SMEs, and drive improvements in claims processing and compliance.

Responsibilities include monitoring SLAs, conducting operational reviews, and delivering audit-ready reporting while collaborating with operations, compliance, and finance teams.