Customer Service Representative

Brighton Health Plan Solutions; New York (NY); On-site; USD 38,000 - 48,000; Full time

Job summary

Brighton Health Plan Solutions is seeking a Customer Service Representative to assist members, physicians and providers with benefits, eligibility, and claims inquiries. You will work Monday through Friday between 9 AM and 7 PM EST, with shifts adjusted as needed.

You will handle high-volume calls, resolve issues on first contact when possible, and collaborate with teams to improve member experience. Strong communication, HIPAA awareness, and multi-channel support are essential.

Qualifications

• High-volume call center experience and claims inquiry/review knowledge.
• Experience in a physician office, group practice, clinic or hospital-based practices.
• HIPAA confidentiality knowledge.
• Strong time management and communication skills.
• Detail-oriented and dependable.
• Flexibility to adapt to changes, with good problem-solving abilities.

Responsibilities

• Handle inbound calls from members, physicians, hospitals, revenue agencies and other healthcare providers.
• Adjust claims accurately, if needed.
• Listen to and address customer needs and concerns empathetically.
• Answer questions about fee schedules, network participation, and requirements.
• Ensure first contact resolution when possible.
• Update customer files and communicate with teams.
• Educate callers and validate their understanding.
• Support projects and other departments as directed by management.

Skills

Call center experience

HIPAA knowledge

Time management

Attention to detail

Multichannel communication

Empathy and listening

Education

High school diploma with some college

Tools

Microsoft Word

Microsoft Excel

Microsoft Access

Microsoft PowerPoint

Microsoft Outlook

Job description

About The Role

The Customer Service Representative assists members, physicians, hospitals, revenue agencies and other healthcare providers with member benefits, eligibility, claims inquiry, claim reconsiderations and appeals. The Customer Service Representatives must be able to work in various shifts Monday to Friday between the hours of 9AM - 7PM EST with the ability to adjust shifts with notice based on business needs.

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

• Handle inbound calls from members, medical providers, and others.
• Adjust claims accurately, if needed.
• Listen to and address customer needs and concerns 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.

Essential Qualifications

The successful candidate will have experience in a high-volume call center, experience with claims inquiry and claims review procedures, knowledge of medical specialties, fee schedules, complaints and appeals and call center responsibilities. Previous experience in a physician's office, group practice, clinic or hospital-based practices.

• High School diploma with some college or business school education preferred.
• Basic computer operations knowledge.
• Intermediate proficiency in Microsoft Office (Word, Excel, Access, PowerPoint, Outlook).
• Strong time management skills.
• General knowledge of HIPAA Confidentiality laws.
• Quick learner with ability to grasp managed care procedures and claims payment policies.
• Detail-oriented and dependable.
• Effective listening and responding skills.
• Flexible and adaptable to changes, with conceptual thinking.
• Strong problem-solving abilities.
• Excellent attendance and punctuality.
• Comfortable performing tasks at a computer/telephone station.
• Effective communication through various channels, including email, chat, and voice.
• Previous multi-channel experience is a plus.

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.

DEI Purpose Statement

At BHPS, we encourage all team members to bring your authentic selves to work with all of your unique abilities. We respect