Remote Case Reviewer I & Customer Support Specialist – Workers’ Compensation & Medicare Set‑Aside Medical Records Analyst – Data‑Driven Claims Review & Customer Experience Expert – Join brighthush’s Innovative Healthcare Claims Team

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. Since our founding in 2012, we have 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 simple yet powerful: simplify the claims process, protect patient rights, and ensure that every stakeholder receives the support they deserve.

At brighthush, 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. Here’s why you’ll love working with us:

• Full Remote Flexibility: Work from anywhere with a competitive salary and a comprehensive benefits package that supports your health, well‑being, and work‑life balance.
• Structured Onboarding & Ongoing Training: Our onboarding program covers medical record review, brighthush guidelines, and advanced case management software, ensuring you hit the ground running.
• Clear Career Pathways: Whether you aspire to become a senior analyst, team lead, or project manager, we provide the mentorship and resources to help you advance.
• Collaborative Environment: Your ideas for process improvement are heard and implemented. We value every voice and encourage cross‑functional collaboration.
• Cutting‑Edge Technology: Access to the latest data analytics tools, AI‑powered insights, and industry‑leading resources keeps you at the forefront of claims review.
• Community & Connection: Regular virtual team events, coffee chats, and a supportive peer network keep you connected, even while working remotely.

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 brighthush 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 and Medicare Set‑Aside proposals and associated medical records, verifying accuracy against brighthush 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 brighthush 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 brighthush 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 brighthush, brighthush, or similar systems.
• Knowledge of regulatory frameworks such as the Workers’ Compensation Act, Medicare Part B, and MSA guidelines.
• Experience with data analytics tools (e.g., Power BI, Tableau) or statistical software.
• Certification in medical coding, health information management, or related fields.

Skills & Competencies

• Analytical Thinking: Ability to dissect complex medical information and regulatory requirements to make accurate decisions.
• Customer‑Centric Mindset: Passion for delivering exceptional service and building trust with patients, providers, and employers.
• Technical Proficiency: Comfortable with cloud‑based case management systems, data entry, and basic troubleshooting.
• Adaptability: Thrive in a fast‑moving environment, quickly adjusting to new processes, tools, and regulatory changes.
• Collaboration & Communication: Strong written and verbal communication skills, with the ability to convey complex information clearly to diverse audiences.
• Time Management: Efficiently juggle multiple priorities, meet deadlines, and maintain high quality under pressure.

Career Growth & Learning Opportunities

At brighthush, we believe in investing in our people. As a Remote Case Reviewer I, you will have access to a wealth of learning resources, including:

• Structured mentorship programs pairing you with senior analysts and project leads.
• Regular training sessions on the latest medical coding standards, regulatory updates, and technology tools.
• Opportunities to lead small projects or process improvement initiatives, building leadership experience.
• Clear promotion pathways to Senior Analyst, Team Lead, or Project Manager roles based on performance and skill development.
• Cross‑departmental exposure to claims strategy, data analytics, and product development teams.

Work Environment & Culture

Our remote-first culture means you can work from anywhere while staying connected to a vibrant, collaborative team. We prioritize:

• Flexibility: Flexible work hours that accommodate your personal commitments.
• Transparency: Open communication channels, regular town‑halls, and feedback loops.
• Innovation: A culture that encourages experimentation, embraces new ideas, and rewards creative problem‑solving.
• Well‑Being: Comprehensive wellness programs, mental health resources, and a supportive peer network.

Compensation & Benefits

While specific figures may vary based on experience, we offer a competitive salary that reflects the value of your expertise. In addition, you will receive:

• Health, dental, and vision insurance plans.
• 401(k) retirement plan with company match.
• Paid time off, holidays, and flexible sick leave.
• Professional development stipend for courses, certifications, and conferences.
• Technology stipend to equip you with the necessary hardware and software.
• Employee assistance program and mental health support.

How to Apply

If you are ready to make a tangible impact on the lives of patients and the financial health of employers, we encourage you to apply today. Submit your resume and a brief cover letter outlining why you’re the perfect fit for the Remote Case Reviewer I & Customer Support Specialist role at brighthush.

We look forward to welcoming you to our team and building a brighter future together.