In-Person Member Support & Claims Specialist

brightonhealthplansolutions; Raleigh (NC); On-site; USD 21,000 - 30,000; Part time

Job summary

Brighton Health Plan Solutions seeks a part-time Customer Service Specialist based in North Carolina. You will provide in-person support to members at an assigned service center, assisting with benefits, eligibility, claims, and appeals.

This role requires professional communication, empathy, and accuracy, with optional Salesforce experience and bilingual abilities preferred to enhance member interactions.

Qualifications

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

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.
• Maintain a professional appearance and demeanor reflecting the organization's standards.

Skills

Customer service

Healthcare experience

Communication skills

Bilingual

Multitasking

Tools

Salesforce

Job description

Brighton Health Plan Solutions seeks a part-time Customer Service Specialist based in North Carolina. You will provide in-person support to members at an assigned service center, assisting with benefits, eligibility, claims, and appeals.

This role requires professional communication, empathy, and accuracy, with optional Salesforce experience and bilingual abilities preferred to enhance member interactions.