Senior Specialist, Vendor Performance Management

Title: Senior Specialist Vendor Performance Management

Job Type: Full-time

Location: Hybrid 4 days per week in Brighton MA office; 1 day remote

FLSA Status: Exempt

About Us

BrightonOine is a nonprofit social enterprise delivering healthcare housing and hope to veterans and military-connected families with enterprise discipline in service to those who served.

Position Overview

The Senior Specialist Vendor Performance Management supports the day-to-day oversight and accountability of USFHPs vendors with subject-matter depth in claims. Reporting to the Director Vendor Performance Management the role manages assigned vendor relationships and performance partners with technical SMEs to define and operationalize SLAs and accountability plans and serves as a claims-process subject-matter expert charged with analyzing performance driving remediation and helping ensure vendors deliver accurate timely compliant service.

Key Responsibilities

Vendor Management & Performance Monitoring

• Manage assigned vendor relationships; monitor performance against SLAs and scorecards and conduct regular operational reviews.
• Partner with technical SMEs to define develop and operationalize vendor accountability plans requirements and corrective actions.
• Track issues and remediation to resolution; support delegation and performance audits with evidence.

Claims Subject-Matter Expertise

• Serve as a subject-matter expert on claims processing adjudication logic edits and vendor claims performance.
• Analyze claims accuracy timeliness and financial data to identify issues root causes and improvement opportunities.
• Support claims configuration validation testing and issue triage with vendors and internal teams.

Reporting & Compliance

• Prepare vendor performance reporting and documentation consistent with TRICARE/USFHP DHA and accreditation requirements.
• Maintain audit-ready records and support governance reporting.

Cross-Functional Collaboration

• Partner with operations compliance finance and clinical teams on vendor issues and process improvements.

Qualifications
Education & Experience

• Bachelors degree preferred or equivalent experience.
• 4 or more years of vendor management claims operations or health plan operations experience.
• Claims operations subject-matter expertise strongly preferred.

Skills & Competencies

• Strong knowledge of claims processing adjudication and vendor/SLA management.
• Analytical and problem-solving skills; ability to drive vendor accountability.
• Excellent communication and collaboration with technical subject-matter experts and vendors.
• Proficiency in Microsoft Office Suite and platforms such as Facets QNXT HealthRules or similar systems.
• Familiarity with CMS URAC NCQA TRICARE and healthcare regulatory requirements.
• Familiarity with CAQH NPPES PECOS and provider credentialing databases.
• High attention to detail and commitment to data accuracy with the ability to analyze complex data and identify discrepancies for regulatory compliance.
• Exceptional organizational and time management skills with the ability to manage multiple priorities in a fast-paced environment.
• Experience with Medicare TRICARE managed care or government-sponsored health programs preferred.

Other Requirements

• Must be able to obtain and maintain U.S. Government personnel security clearance as a condition of employment.

Physical Nature of the Job

Some elements of the job are sedentary but the employee will be required to stand for periods of time or move throughout the campus.

Equal Opportunity Employer Statement

BrightonOne is an Equal Opportunity Employer. We prohibit discrimination and harassment of any kind based on race color religion sex (including pregnancy gender identity and sexual orientation) national origin age disability genetic information protected veteran status or any other characteristic protected by federal state or local law. We strongly encourage applications from veterans and individuals with disabilities. Accommodations are available upon request for candidates taking part in all aspects of the selection process.

Work Authorization

Candidates must be authorized to work in the United States without sponsorship now or in the future.