The representative handles inbound calls from members and medical providers to address inquiries regarding benefits, eligibility, and appeals. They are responsible for updating customer files, resolving issues, and collaborating with team members to ensure high-quality service.
About The Role The Customer Service Representative assists members, physicians, hospitals, and other healthcare providers with member benefits, eligibility, and appeals. The Customer Service Representatives must be able to work in various shifts Monday to Friday between the hours of 9AM – 5PM EST. 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. *This is a Remote Role
Primary Responsibilities
Handle inbound calls from members, medical providers, and others.
Listen to and address customer needs and concerns empathetically.
Answer questions about, network participation
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.
Collaborate with other team members.
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 medical specialties, 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.
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.
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 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 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
JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Brighton Health Plan Solutions in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All of our career opportunities are regularly published and updated brighonthps.com Careers section. If you have already provided your personal information, please report it to your local authorities. Any fraudulent activity should be reported to: recruiting@brightonhps.com
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