Senior Group Health Customer Service Representative – Claims Intake & Physician Coordination Specialist at brighthush

About brighthush

brighthush is a leading independent medical review and claims management firm that serves a diverse portfolio of national and regional workers’ compensation, disability, auto, and group health carriers, third‑party administrators, managed care organizations, employers, and pharmacy benefit managers. With a proven track record of processing more than 200,000 insurance claims annually, we provide customized independent medical exams and peer‑review programs that help our clients reach accurate medical determinations and improve overall claims outcomes. Our culture is built on high performance, continuous learning, and a commitment to diversity, equity, and inclusion.

Position Overview

We are seeking a highly motivated, detail‑oriented professional to join our remote team as a Group Health Customer Service Representative. In this role, you will be the linchpin between our clients, physicians, and internal operations, ensuring that every referral is handled efficiently, accurately, and in compliance with all regulatory and client‑specific requirements. Your work will directly impact the quality of care our clients receive and the speed at which claims are resolved.

Key Responsibilities

• Intake & Verification: Receive new referral cases, review all submitted information, and verify completeness. Draft case entries into the brighthush system, ensuring data integrity and adherence to internal quality standards.
• Client Collaboration: Engage with referring clients to gather missing documentation, clarify ambiguous details, and provide status updates. Maintain a professional, courteous tone across all communications.
• Document Management: Organize, sort, and create medical document listings as required by client specifications, ensuring that all files are properly labeled and stored for easy retrieval.
• Case Oversight: Monitor the progress of each case, track deadlines, and flag any delays or issues that could impact client satisfaction or regulatory compliance.
• Physician Assignment: Assign or schedule cases to appropriate physicians based on location, availability, jurisdictional rules, and client preferences. Verify that assigned physicians have no conflict of interest.
• Quality Assurance: Conduct periodic audits of case files to confirm that all required documentation is present and that physician reports meet our quality benchmarks.
• Communication Hub: Serve as the primary point of contact for both clients and physicians, answering questions, resolving discrepancies, and ensuring that all parties are aligned on expectations.
• Process Improvement: Identify bottlenecks or inefficiencies in the intake and assignment workflow and propose actionable solutions to senior management.

Essential Qualifications

• Minimum of 1 year of experience in an administrative or clerical role within a business office environment.
• Experience in a healthcare setting—such as a medical office, insurance claims, or related field—is highly preferred.
• Proficiency with Apple operating systems, Google Chrome, Gmail, and other standard office productivity tools.
• Exceptional written and verbal communication skills, with the ability to articulate complex information clearly to clients, claimants, and physicians.
• Strong organizational skills and the capacity to manage multiple tasks simultaneously in a fast‑paced environment.
• High attention to detail and a commitment to maintaining data accuracy and confidentiality.
• Ability to adapt quickly to changing priorities and to work independently with minimal supervision.
• Associate’s degree or equivalent experience; a bachelor’s degree is a plus.

Preferred Qualifications

• Prior experience with medical claim intake or physician scheduling systems.
• Knowledge of workers’ compensation, disability, or group health claim processes.
• Familiarity with HIPAA regulations and other privacy standards governing medical information.
• Experience using case management or electronic health record (EHR) platforms.
• Demonstrated ability to work remotely, including reliable high‑speed internet and a dedicated workspace.

Core Competencies & Skills

• Client‑Centric Mindset: A genuine desire to help clients achieve their goals and to provide a seamless experience.
• Analytical Thinking: Ability to interpret data, identify trends, and recommend improvements.
• Problem‑Solving: Quick to diagnose issues and develop practical solutions.
• Time Management: Prioritizes tasks effectively to meet tight deadlines.
• Collaboration: Works well with cross‑functional teams, including technical, operations, and physician partners.
• Adaptability: Comfortable with evolving processes and technology updates.

Career Growth & Learning Opportunities

At brighthush, we believe that professional development is a shared responsibility. As a Customer Service Representative, you will have access to a range of learning resources, including:

• On‑the‑job training with seasoned mentors who guide you through the intricacies of medical claim intake and physician coordination.
• Online courses and certifications in healthcare administration, medical billing, and compliance.
• Quarterly workshops focused on emerging industry trends, regulatory changes, and best practices.
• Clear advancement pathways to roles such as Case Manager, Operations Lead, or Client Services Manager.

We also encourage cross‑departmental shadowing, enabling you to gain a holistic view of our operations and identify future career interests.

Work Environment & Culture

Our remote‑first model empowers you to work from anywhere while staying connected to a vibrant, collaborative team. We foster a culture of transparency, accountability, and mutual respect. Regular virtual town halls, informal coffee chats, and team‑building events keep our community engaged and energized. Diversity and inclusion are not buzzwords at brighthush—they are the foundation of our decision‑making and innovation.

Compensation & Benefits

We offer a competitive base salary that reflects your experience, education, and skill set. In addition, you will receive a comprehensive benefits package designed to support your health, well‑being, and financial security:

• Health, dental, and vision insurance for you and your family.
• Voluntary life insurance, hospital indemnity, critical illness, and accident coverage.
• Short‑term and long‑term disability protection at no cost.
• Generous paid time off (PTO) and paid holidays.
• 401(k) plan with company match to help you plan for the future.
• Apple equipment and a media stipend to create an optimal home office.
• Performance‑based bonuses and recognition programs.

Our commitment to fair and competitive compensation ensures that your contributions are valued and rewarded.

How to Apply

Ready to join a forward‑thinking team that values your expertise and supports your growth? Click the link below to submit your application and take the first step toward an exciting career at brighthush.