Casualty Support Coordinator

About The Role

Casualty Support Coordinators facilitate care management and utilization review by performing data collection & data entry, and effectively communicating with Nurse Case Reviewers/Managers, providers, employers and claimants in regard to claimants’ workers’ compensation cases. Provide education and issue resolution to MagnaCare network providers and customers, for the Workers’ Compensation and No-Fault lines of business. Work closely with both providers and customers, when there is a dispute raised by a network provider or customer. Maintain comprehensive knowledge of provider and company specific policies and procedures. Partner with Provider Contracting, Sales, Medical Management and Operations Department in identifying and resolving provider issues. The Casualty Support Coordinator reports to the manager of Casualty Support.

The successful candidate will be afforded an opportunity to help further structure this team. This team is a critical component to the delivery of quality healthcare services.

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.

Primary Responsibilities

• Collect data from claimant representative, physician, or hospital; verify claimant case status and provider participation status
• Create cases within Medical Management system in accordance with departmental workflows, policies and procedures
• Assist Nurse Case Reviewers with non-clinical issues (i.e. requesting clinical information from provider, obtaining proper forms, work status)
• Data entry of required case demographics including transcription of clinical information
• Answer incoming group phone calls and interact telephonically with employers, employees, physicians and insurance adjusters to acquire information about medical status, and/or type of care needed in a timely manner
• Schedule medical appointments for members with in-network facilities and providers and coordinate/verify member attendance at the appointment
• Maintain and update all activity trackers within designated timeframes
• Assure accurate verification of claimant cases; create, scan, fax, mail and upload correspondence and documentation as required
• Adhere to established quality assurance standards and all MagnaCare policies and procedures
• Educate providers on current policies, trends and information affecting their participation within the MagnaCare network
• Act as liaison for interpretation of No-Fault and Workers Comp contracts
• Respond to inquiries specifically related to the provider’s contract or claim issue
• Research provider contract/claim issues received by the provider or the client, and perform claims analysis
• Maintain database for provider issues and creating detailed reports as needed
• Coordinate efforts with members of the management team in developing short and long term plans that result in high performance provider services
• Perform Ad-Hoc projects and support departmental initiatives as needed
• Discuss and document any concerns, complaints and/or issues with direct supervisor
• Demonstrates a kind, caring, sympathetic and positive attitude with all customers and fellow employees
• Adhere to established quality assurance standards and all MagnaCare policies and procedures
  
  

Essential Qualifications

• Strong PC skills (Excel is a must)
• Excellent organizational and problem-solving skills
• Strong working knowledge of IMPACT claims system a plus
• Notary License a plus
• Ability to maintain professional demeanor under pressure
• Ability to work independently and as a team player
• Minimum of one years’ experience
• Bachelor's degree or equivalent experience
• Bilingual preferred, but not required
• Previous experience in case management handling insurance claims a plus
• Strong skills in medical record review
• Familiarity with medical terminology a plus
• Current knowledge of workers compensation and legislative issues a plus
• Knowledge of the health insurance industry, products and services
• Familiarity with claims and claims processing
• Strong follow up, negotiating and influencing skills
• Capable of managing multiple complex issues
  
  

About

At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion, and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all your unique abilities.

Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes, and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions.

Come be a part of the Brightest Ideas in Healthcare™.

Company Mission

Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.

Company Vision

Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.

DEI Purpose Statement

At BHPS, we encourage all team members to bring your authentic selves to work with all your unique abilities. We respect how you experience the world and welcome you to bring the fullness of your lived experience into the workplace. We are building, nurturing, and embracing a culture focused on increasing diversity, inclusion and a sense of belonging at every level.

• We are an Equal Opportunity Employer
  
  

JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Brighton Health Plan Solutions in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All of our career opportunities are regularly published and updated brighonthps.com Careers section. If you have already provided your personal information, please report it to your local authorities. Any fraudulent activity should be reported to:

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