Care Coordination Specialist – Workers’ Comp & No-Fault

Brighton Health Plan Solutions; United States; On-site; USD 42,000 - 54,000; Full time

Job summary

Brighton Health Plan Solutions is seeking a Care Coordinator to support utilization review and case management for workers’ compensation and no fault claims. You will collect data, set up cases, and coordinate with Nurse Case Reviewers, employers, and providers to ensure timely, accurate information flow.

The role emphasizes strong communication, organizational skills, and the ability to work independently or as part of a team in a medical environment.

Qualifications

• Superior oral and written communication skills.
• Strong PC skills with Excel proficiency.
• Excellent organizational skills.
• Minimum of one year’s experience in the medical field.
• Bachelor's degree or equivalent experience.
• Bilingual preferred, but not required.
• Previous experience in case management handling insurance claims a plus.
• Strong knowledge of medical terminology and workers' compensation concepts.

Responsibilities

• Collect data from claimant representative, physician, or hospital; verify claimant case status and network status.
• Set up cases in the system per workflows and policies.
• Assist Nurse Case Reviewers with non-clinical tasks like requesting clinical information and forms.
• Enter required case demographics and transcribe clinical information.
• Handle calls with 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; create, scan, and upload correspondence and documentation.
• Follow quality assurance standards and policies; report concerns to supervisor.
• Demonstrate a caring attitude with customers and colleagues.
• Support ad-hoc projects and departmental initiatives as needed.

Skills

Oral & Written Communication

Organizational Skills

Teamwork

Professional Demeanor Under Pressure

Education

Bachelor's degree or equivalent experience

Tools

Excel

Job description

Brighton Health Plan Solutions is seeking a Care Coordinator to support utilization review and case management for workers’ compensation and no fault claims. You will collect data, set up cases, and coordinate with Nurse Case Reviewers, employers, and providers to ensure timely, accurate information flow.

The role emphasizes strong communication, organizational skills, and the ability to work independently or as part of a team in a medical environment.