Customer Service Specialist- Onsite P/T

Brighton Health Plan Solutions, LLC; Raleigh (NC); On-site; USD 18,000 - 28,000; Part time

Job summary

Brighton Health Plan Solutions, LLC in Raleigh, NC is seeking a part-time Customer Service Specialist to assist members in person at an assigned service center.

You will address benefits, eligibility, claims inquiries, and appeals, listen empathetically, and document interactions clearly while following privacy and regulatory guidelines.

The role requires strong communication, experience in healthcare settings, and the ability to navigate multiple inquiries during walk-in hours.

Qualifications

• Prior customer service experience, preferably in healthcare or insurance.
• Experience in walk-in service center providing in-person support.
• Knowledge of claims review procedures, appeals, and grievance processes.
• Strong communication skills and the ability to explain complex information with empathy.
• Ability to manage multiple inquiries with attention to detail.
• Salesforce experience preferred.
• Bilingual preferred.
• Proficient in Microsoft Word, Excel, Outlook.

Responsibilities

• Provide in-person support to members at the service center regarding benefits, eligibility, claims, and appeals.
• Handle escalated member concerns, inquiries, and complaints in a professional and timely manner.
• Actively listen to customer concerns, demonstrating empathy and offering effective solutions.
• Analyze and resolve non-standard and complex issues using critical thinking and problem-solving skills.
• Document all interactions and resolutions accurately in the system to ensure seamless customer service.
• Adhere to regulatory requirements, company policies, and confidentiality guidelines when handling member information.
• Maintain a professional appearance and demeanor that reflects the organization's standards.

Skills

Customer service

Healthcare knowledge

Communication skills

Bilingual (preferred)

Salesforce experience

MS Office proficiency

Tools

Salesforce

Microsoft Office

Job description

About The Role

Brighton Health Plan Solutions seek a detail-oriented and empathetic North Carolina-based Customer Service Specialist to join our team. In this part-time role, you will provide in-person support to our members at an assigned service center location. You will assist customers with member benefits, eligibility, claims inquiries, claim reconsiderations and appeals at the on-site facility. This position requires regular face-to-ace interaction with members and, during periods of lower walk-in volume, will also support customer service inquiries received by phone.

*Working Hours will be Monday through Friday 10am-2pm EST.

Primary Responsibilities

• Provide timely and professional in-person support to members regarding benefits, eligibility, claims, and appeals.
• Handle escalated member concerns, inquiries, and complaints in a professional and timely manner.
• Actively listen to customer concerns, demonstrating empathy and offering effective solutions.
• Analyze and resolve non-standard and complex issues using critical thinking and problem-solving skills.
• Maintain a thorough understanding of health plan benefits, policies, procedures, and client-specific requirements to provide accurate guidance.
• Document all interactions and resolutions accurately in the system to ensure seamless customer service.
• Adhere to regulatory requirements, company policies, and confidentiality guidelines when handling member information.
• Maintains a professional appearance and demeanor that reflects the organization's standards

Essential Qualifications

• Prior customer service experience, preferably in healthcare, insurance, or a related field is required.
• Experience in a walk-in service center or similar environments providing in-person support.
• Knowledge of claims review procedures appeals and grievance processes, medical terminology, provider specialties, and fee schedules preferred.
• Strong communication skills with the ability to explain complex information in a clear and empathetic manner.
• Ability to manage multiple inquiries while maintaining attention to detail and accuracy.
• Problem-solving skills and the ability to navigate complex eligibility and claims issues.
• Strong communication skills with the ability to explain complex information in a clear and empathetic manner.
• Salesforce experience preferred.
• Bilingual preferred.
• Ability to de-escalate challenging situations while maintaining a positive member experience.
• Intermediate proficiency in Microsoft Office (Word, Excel, Outlook).

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.