Bilingual Claims & Member Support Specialist

Brighton Health Plan Solutions; Houston (TX); On-site; USD 46,000 - 48,000; Full time

Job summary

Brighton Health Plan Solutions in Houston, TX, is seeking a bilingual Customer Service Representative to assist members, providers, and plans with benefits, eligibility, and claims inquiries.

You will handle high-volume calls, adjust claims, educate callers, and support multi-channel communications while maintaining HIPAA compliance and patient privacy.

This role offers a collaborative environment focused on service quality, growth, and making healthcare more accessible for diverse communities.

Qualifications

• Experience in a high-volume call center with claims inquiry and review procedures.
• Knowledge of medical specialties, fee schedules, complaints and appeals.
• Experience in a physician's office, group practice, clinic or hospital-based practices.
• Fluent in both Spanish and English.
• Strong time management and attention to detail.

Responsibilities

• Handle inbound calls from members, medical providers, and others.
• Adjust claims accurately, if needed.
• Listen to and address customer needs empathetically.
• Answer questions about fee schedules, network participation, and requirements.
• Ensure first contact resolution when possible.
• Update customer files and communicate effectively with teams.
• Transfer misdirected requests and offer solutions to non-routine issues.
• Contribute to customer satisfaction and business improvement.
• Use decision-support tools to provide accurate responses.
• Investigate inquiries using training and systems.
• Adapt responses to caller understanding.
• Educate callers and validate their understanding.
• Support projects and other departments as directed by management.

Skills

Bilingual Spanish/English

Education

High School diploma

Some college education

Tools

Microsoft Office

Job description

Brighton Health Plan Solutions in Houston, TX, is seeking a bilingual Customer Service Representative to assist members, providers, and plans with benefits, eligibility, and claims inquiries.

You will handle high-volume calls, adjust claims, educate callers, and support multi-channel communications while maintaining HIPAA compliance and patient privacy.

This role offers a collaborative environment focused on service quality, growth, and making healthcare more accessible for diverse communities.