Remote Case Reviewer I & Customer Support Specialist – Workers’ Compensation & Medicare Set‑Aside Medical Records Analyst

About brighthush

brighthush is a forward‑thinking, technology‑driven organization that empowers individuals and businesses to navigate the complex world of workers’ compensation, Medicare Set‑Asides (MSA), and related healthcare claims with confidence and clarity. Founded in 2012, brighthush has grown into a trusted partner for employers, insurers, and healthcare providers across the United States, delivering data‑rich insights, streamlined case management, and exceptional customer service. Our mission is to simplify the claims process, protect patient rights, and ensure that every stakeholder receives the support they deserve.

At brighthush, we believe that people are at the heart of everything we do. Our culture is built on collaboration, continuous learning, and a commitment to excellence. We celebrate diversity, encourage innovation, and provide our team members with the tools, training, and opportunities they need to grow both personally and professionally.

Why Join brighthush?

As a Remote Case Reviewer I & Customer Support Specialist, you will be part of a dynamic, high‑impact team that directly influences the quality of care and financial outcomes for thousands of patients and employers. You’ll enjoy:

• Full remote flexibility with a competitive salary and comprehensive benefits package.
• Structured onboarding and ongoing training that covers medical record review, CMS guidelines, and advanced case management software.
• Clear career pathways—from entry‑level reviewer to senior analyst, team lead, or project manager.
• A collaborative environment where your ideas for process improvement are heard and implemented.
• Access to cutting‑edge technology, data analytics tools, and industry‑leading resources.
• Regular team events, virtual coffee chats, and a supportive peer network.

Key Responsibilities

In this role, you will be the frontline guardian of quality and compliance, ensuring that every case meets the rigorous standards set by CMS and our internal protocols. Your day‑to‑day activities will include:

• Customer Interaction: Respond promptly to inquiries via phone, email, and chat, providing courteous, professional assistance and resolving issues efficiently.
• Case Review & Documentation: Examine Workers’ Compensation Medicare Set‑Aside proposals and associated medical records, verifying accuracy against CMS threshold requirements and internal guidelines.
• Data Integrity: Maintain meticulous, up‑to‑date records of all customer interactions and case reviews, ensuring traceability and audit readiness.
• Compliance & Quality Assurance: Apply complex regulatory frameworks consistently, flagging discrepancies and initiating corrective actions as needed.
• Process Improvement: Collaborate with cross‑functional teams to identify bottlenecks, propose enhancements, and implement best practices.
• Team Collaboration: Participate in daily huddles, knowledge‑sharing sessions, and training workshops to stay current on industry trends and internal procedures.
• Administrative Support: Handle documentation requests, data entry, and other administrative tasks that support the smooth operation of the case review workflow.
• Continuous Learning: Engage in ongoing professional development to deepen your medical literacy, regulatory knowledge, and technical skills.

Essential Qualifications

• High School Diploma or GED (required). Associate degree or coursework in Healthcare Administration, Paralegal Studies, or a related field is highly desirable.
• Minimum of 1 year of customer service experience in a call center or inbound support environment.
• Strong medical literacy: ability to navigate, interpret, and evaluate complex medical documents, including physician notes, lab reports, and imaging studies.
• High attention to detail and analytical mindset for verifying documentation against CMS threshold requirements.
• Proficiency with Microsoft Office Suite (Word, Excel, Outlook) and comfort learning case management software and databases.
• Fast, accurate data entry skills for maintaining customer records and case review notes.
• Excellent verbal and written communication skills, with a professional, empathetic telephone demeanor.
• Active listening skills to understand customer needs, resolve inquiries efficiently, and de‑escalate calls when necessary.
• Strong team player with a collaborative attitude and a willingness to share process improvement ideas.
• Strong organizational and time‑management skills, with the ability to prioritize daily task loads between live calls and desk reviews.
• Ability to follow complex, standardized regulatory guidelines strictly and consistently.
• High degree of discretion when handling confidential patient and claim information.
• Prior experience handling medical records, insurance claims, or legal documentation is a plus.
• Basic understanding of Workers’ Compensation, Medicare Set‑Aside (MSA) proposals, or CMS guidelines is preferred.

Preferred Qualifications

• Experience in a healthcare claims environment, particularly with workers’ compensation or Medicare Set‑Asides.
• Familiarity with case management platforms such as CaseWare, Medisoft, or similar systems.
• Knowledge of HIPAA regulations and data privacy best practices.
• Certification in medical coding (e.g., CPT, ICD‑10) or related fields.
• Experience in process improvement initiatives, Lean Six Sigma, or quality assurance projects.

Skills & Competencies

• Customer‑centric mindset with a passion for delivering exceptional service.
• Strong analytical and problem‑solving abilities.
• Adaptability to changing priorities and evolving regulatory landscapes.
• Excellent written and verbal communication skills.
• Proficiency in data entry, spreadsheet analysis, and report generation.
• Team collaboration and cross‑functional communication.
• Self‑motivation and a proactive approach to continuous improvement.

Career Growth & Learning Opportunities

At brighthush, we are committed to nurturing talent and providing clear pathways for advancement. As a Case Reviewer I, you will have the opportunity to:

• Progress to a Senior Case Reviewer role, taking on more complex cases and mentoring junior staff.
• Transition into a Team Lead or Manager position, overseeing a group of reviewers and shaping team strategy.
• Move into a Project Management or Process Improvement role, driving initiatives that enhance efficiency and quality.
• Explore specialized tracks in medical coding, regulatory compliance, or data analytics.
• Participate in leadership development programs, workshops, and industry conferences.

Work Environment & Culture

brighthush embraces a flexible, inclusive, and collaborative culture. Our remote-first approach means you can work from anywhere in the United States, while still feeling connected to a vibrant team. We value:

• Open communication and transparency.
• Respect for work‑life balance.
• Continuous learning and professional growth.
• Recognition of achievements and contributions.
• Innovation and a willingness to challenge the status quo.

Compensation & Benefits

While specific salary ranges are tailored to experience and qualifications, brighthush offers a competitive compensation package that includes:

• Base salary commensurate with industry standards.
• Paid training and onboarding.
• Paid holidays and vacation leave in accordance with U.S. labor laws.
• 401(k) retirement plan with employer match starting after 6 months of employment.
• Life insurance with 100% employer contribution.
• Health & Welfare (H&W) contributions to support medical, dental, and vision coverage.
• Flexible spending accounts (FSAs) and health savings accounts (HSAs) for out‑of‑pocket medical expenses.
• Professional development stipend for courses, certifications, and conferences.
• Employee assistance program (EAP) for mental health and well‑being support.
• Regular wellness initiatives, such as virtual fitness classes and mindfulness sessions.

How to Apply

Ready to make a meaningful impact in the world of workers’ compensation and Medicare Set‑Asides? Submit your application through our careers portal or click the link below to apply directly. We look forward to learning how your skills and passion align with brighthush’s mission to deliver excellence in customer support and case review.