Care Coordination Specialist, Workers’ Comp & Claims

brightonhealthplansolutions; Chapel Hill (NC); On-site; USD 42,000 - 62,000; Full time

Job summary

Brighton Health Plan Solutions is seeking a detail-oriented Care Coordinator to support utilization review and case management for workers’ compensation claims. You will collect data, enter demographics, and communicate with nurses, employers, and claimants to ensure timely information flow.

The role emphasizes accuracy, organization, and the ability to work independently or as part of a team, with opportunities to contribute to process improvements and standalone projects.

Qualifications

• Bachelor's degree or equivalent experience required.
• At least 1 year of experience in the medical field.
• Strong communication and organizational skills required.
• Bilingual preferred but not required.
• Familiarity with workers' compensation and insurance claims is a plus.

Responsibilities

• Collect data from claimant representatives, physicians, or hospitals and verify case status.
• Set up cases in the system per workflows and policies.
• Assist Nurse Case Reviewers with non-clinical tasks like requesting information from providers.
• Enter required case demographics and transcribe clinical information.
• Handle incoming calls from employers, employees, physicians, and adjusters to gather medical status and care needs.
• Schedule medical appointments with in-network facilities and coordinate attendance.
• Maintain and update activity trackers within designated timeframes.
• Verify claimant cases and manage correspondence/document uploads.
• Follow QA standards and company policies.
• Report concerns to supervisor; maintain a kind, caring attitude.
• Perform ad-hoc projects and support department initiatives.

Skills

Communication skills

Excel

Organization

Professional demeanor

Teamwork

Independent work

Education

Bachelor's degree or equivalent experience

1+ years medical field experience

Job description

Brighton Health Plan Solutions is seeking a detail-oriented Care Coordinator to support utilization review and case management for workers’ compensation claims. You will collect data, enter demographics, and communicate with nurses, employers, and claimants to ensure timely information flow.

The role emphasizes accuracy, organization, and the ability to work independently or as part of a team, with opportunities to contribute to process improvements and standalone projects.