MagnaCare
About The Role
Brighton Health Plan Solutions provides Utilization Review/Case Management/Medical Management/Claims Review services. Care Coordinators facilitate care management and utilization review by performing data collection & data entry, and communicating with Nurse Case Reviewers/Managers, employers and claimants regarding workers’ compensation cases. Provide claims processing for the Workers’ Compensation and No Fault lines of business. The successful candidate will help further structure this team, a critical component in delivering quality healthcare services.
Primary Responsibilities
Collect data from claimant representative, physician, or hospital; verify claimant case status and provider network status.
Set up cases in system in accordance with departmental workflows, policies and procedures.
Assist Nurse Case Reviewers with non-clinical tasks such as requesting clinical information from providers, obtaining necessary forms, and confirming work status.
Enter required case demographics and transcribe clinical information.
Handle incoming group phone calls and interact with employers, employees, physicians and insurance adjusters to gather information about medical status, and/or type of care needed in a timely manner.
Schedule medical appointments for members with in-network facilities and providers and coordinate/verify member attendance at the appointment.
Maintain and update all activity trackers within designated timeframes.
Verify and ensure the accuracy of claimant cases; create, scan, fax, mail, and upload correspondence and documentation as needed.
Follow established quality assurance standards and all policies and procedures.
Report and document any concerns, complaints and/or issues with direct supervisor.
Demonstrate a kind, caring, sympathetic and positive attitude with all customers and fellow employees.
Perform ad-hoc projects and support departmental initiatives as needed.
Essential Qualifications
Superior oral and written communication skills.
Strong PC skills (Excel is a must).
Excellent organizational skills.
Ability to maintain professional demeanor under pressure.
Ability to work independently and as a team player.
Minimum of one year’s experience in the medical field.
Bachelor degree or equivalent experience.
Bilingual preferred, but not required.
Previous experience in case management handling insurance claims a plus.
Strong skills in medical record review.
Familiarity with medical terminology.
Current knowledge of workers’ compensation and legislative issues a plus.
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 of 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.
Equal Opportunity Employer We are an Equal Opportunity Employer.
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 on 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: recruiting@brightonhps.com.
Seniority Level
Entry level
Employment Type
Full‑time
Job Function
Sales, General Business, and Education
Industries
Wireless Services, Telecommunications, and Communications Equipment Manufacturing
#J-18808-Ljbffr
Primary Responsibilities
Collect data from claimant representative, physician, or hospital; verify claimant case status and provider network status.
Set up cases in system in accordance with departmental workflows, policies and procedures.
Assist Nurse Case Reviewers with non-clinical tasks such as requesting clinical information from providers, obtaining necessary forms, and confirming work status.
Enter required case demographics and transcribe clinical information.
Handle incoming group phone calls and interact with employers, employees, physicians and insurance adjusters to gather information about medical status, and/or type of care needed in a timely manner.
Schedule medical appointments for members with in-network facilities and providers and coordinate/verify member attendance at the appointment.
Maintain and update all activity trackers within designated timeframes.
Verify and ensure the accuracy of claimant cases; create, scan, fax, mail, and upload correspondence and documentation as needed.
Follow established quality assurance standards and all policies and procedures.
Report and document any concerns, complaints and/or issues with direct supervisor.
Demonstrate a kind, caring, sympathetic and positive attitude with all customers and fellow employees.
Perform ad-hoc projects and support departmental initiatives as needed.
Essential Qualifications
Superior oral and written communication skills.
Strong PC skills (Excel is a must).
Excellent organizational skills.
Ability to maintain professional demeanor under pressure.
Ability to work independently and as a team player.
Minimum of one year’s experience in the medical field.
Bachelor degree or equivalent experience.
Bilingual preferred, but not required.
Previous experience in case management handling insurance claims a plus.
Strong skills in medical record review.
Familiarity with medical terminology.
Current knowledge of workers’ compensation and legislative issues a plus.
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 of 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.
Equal Opportunity Employer We are an Equal Opportunity Employer.
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 on 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: recruiting@brightonhps.com.
Seniority Level
Entry level
Employment Type
Full‑time
Job Function
Sales, General Business, and Education
Industries
Wireless Services, Telecommunications, and Communications Equipment Manufacturing
#J-18808-Ljbffr