• Conduct proactive outreach to engage members in case management programs.
• Answer and manage incoming calls within established performance timeframes.
• Send correspondence, resources, and educational materials to members via mail or email.
• Collect clinical and demographic information from members, representatives, and providers; verify eligibility as needed.
• Create and update cases within the Case Management system in accordance with departmental policies and workflows.
• Conduct initial clinical intake assessments to determine acuity and routing needs; escalate to RN Case Managers when appropriate.
• Communicate effectively with members and healthcare providers to gather and relay clinical information regarding diagnoses, medical status, and care needs.
• Maintain accurate documentation, adhering to BHPS policies, procedures, and quality assurance standards.
• Identify and communicate concerns, complaints, or issues to the direct supervisor promptly.
• Demonstrate Brighton’s core values through professionalism, empathy, and a positive, customer‑focused approach.

• High school diploma or GED.
• Strong skills in reviewing medical records and clinical information.
• Excellent customer service and written/verbal communication skills.
• Ability to think critically, gather data, and identify facts.
• Proficiency with PC systems, including Microsoft Word and Excel.
• Strong data entry accuracy and attention to detail.
• Ability to work independently, manage tasks, and demonstrate strong organizational skills.
• Ability to work flexible hours, including availability after 5 p.m. as needed.

• Bachelor’s degree.
• Familiarity with medical terminology.
• Experience working in a database environment.
• Previous customer service or medical office experience.
• Demonstrated ability to learn new software programs.

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 of 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.

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: [email protected]