Customer Service Representative

Brighton Health Plan Solutions; United States; Remote; USD 40,000 - 48,000; Full time

Job summary

Join a forward-thinking healthcare enablement company as a Customer Service Representative. In this remote role, you will assist members and healthcare providers with inquiries, claims, and benefits, ensuring a high level of customer satisfaction. Your ability to adapt to various shifts and communicate effectively will be key in this dynamic environment. This innovative firm values diversity and encourages you to bring your authentic self to work. With a focus on transforming healthcare access and delivery, you'll be part of a team dedicated to improving the member experience and achieving healthcare goals.

Benefits

Medical Insurance

Vision Insurance

401(k)

Paid Paternity Leave

Paid Maternity Leave

Disability Insurance

Qualifications

• Experience in a high-volume call center with claims inquiry.
• Knowledge of medical specialties and HIPAA confidentiality laws.

Responsibilities

• Handle inbound calls and address customer needs empathetically.
• Adjust claims accurately and ensure first contact resolution.

Skills

Customer Service

Claims Inquiry

Problem-Solving

Effective Communication

Detail-Oriented

Education

High School Diploma

Some College or Business School Education

Tools

Microsoft Office

Decision-Support Tools

Job description

Direct message the job poster from Brighton Health Plan Solutions

Lead Recruiter at Brighton Health Plan Solutions

Customer Service Representative

Brighton Health Plan Solutions

REMOTE – 100%

Full Time

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).

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 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

Annual Salary Range: $40,560 - $47,840

The salary range and/or hourly rate listed is a good faith determination that may be offered to a successful applicant for this position at the time of the posting of an advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable by law including but not limited to location, years of relevant experience, education, credentials, skills, budget and internal equity.

Seniority level

• Seniority level

  Associate

Employment type

• Employment type

  Full-time

Job function

• Job function

  Customer Service

• Industries

  Insurance, Hospitals and Health Care, and Insurance and Employee Benefit Funds

Referrals increase your chances of interviewing at Brighton Health Plan Solutions by 2x

Inferred from the description for this job

Medical insurance

Vision insurance

401(k)

Paid paternity leave

Paid maternity leave

Disability insurance

Get notified about new Customer Service Representative jobs in United States.

Call Center Customer Service Representative

Ohio, United States $17.75-$19.99 3 weeks ago

Remote Call Center Customer Service Representative

South Carolina, United States 3 months ago

Customer Service Representative (Remote)

Healthcare Customer Service Representative - Inbound

Remote PT Customer Experience Agent - $20/hr

Member Services - Customer Service Representative

Remote Call Center Customer Service Representative

San Francisco, CA $19.00-$20.00 4 weeks ago

Remote Call Center Customer Service Representative

Inbound Customer Service Agent-Bodewell (Remote)

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.