Customer Service Representative/ Bilingual (Spanish)

MagnaCare; New York (NY); On-site; USD 46,000 - 48,000; Full time

Benefits offered by this job

Equal Opportunity Employer

Job summary

Brighton Health Plan Solutions, LLC is seeking a bilingual Customer Service Representative to assist members and providers with benefits and eligibility. The role requires handling claims inquiries, reconsiderations, and appeals with care, in a fast-paced environment in New York.

The ideal candidate will have experience in a high-volume call center, strong Spanish/English communication, basic computer skills, and HIPAA knowledge, supporting projects across departments as needed.

Qualifications

• Experience in high-volume call center environments with claims inquiries and reviews.
• Bilingual in Spanish and English required; familiarity with healthcare terminology.
• Basic computer operations and MS Office proficiency; HIPAA confidentiality awareness.

Responsibilities

• Handle inbound calls from members and healthcare providers regarding benefits and eligibility.
• Address claims inquiries, reconsiderations, and appeals with accuracy and empathy.
• Update files and coordinate with internal teams to resolve issues on first contact where possible.
• Explain fee schedules, network participation, and requirements; ensure effective communication.
• Support management and other departments on projects; prior multi-channel experience is a plus.

Skills

Bilingual Spanish/English

Customer service

Multichannel communication

Time management

HIPAA knowledge

Empathy

Education

High School diploma

Some college / business school

Tools

Microsoft Office

Job description

About The Role

The Customer Service Representative, Bilingual, 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.

About The Role

The Customer Service Representative, Bilingual, 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
• Previous multi-channel experience is a plus

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
• Fluent in both Spanish and English
• 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 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: $45,760 - $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.