Customer Service Representative

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.

This position requires availability to work various shifts Monday to Friday between the hours of 9 AM – 7 PM EST, with the ability to adjust shifts based on business needs.

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

Requirements

• Experience in a high-volume call center
• Experience with claims inquiry and claims review procedures
• Knowledge of medical specialties, fee schedules, complaints, and appeals
• Previous experience in a physician’s office, group practice, clinic, or hospital-based practices
• High School diploma; 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 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 the company

At Brighton Health Plan Solutions, LLC, our people are committed to improving how healthcare is accessed and delivered. We foster a diverse and welcoming culture focused on encouragement, respect, and increasing diversity, inclusion, and a sense of belonging at every level. Employees are encouraged to bring their authentic selves to work with all their unique abilities.

Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers, and other TPAs. We enable them to solve today’s healthcare challenges with flexible and cutting-edge third-party administration services. Our unique perspective comes from decades of health plan management expertise, proprietary provider networks, and an innovative technology platform.

As a healthcare enablement company, we unlock opportunities that provide clients with customizable tools 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.

Pay

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 at the time of posting and may be modified in the future. When determining a team member's base salary, several factors may be considered, including but not limited to location, years of relevant experience, education, credentials, skills, budget, and internal equity.

Schedule

Various shifts Monday to Friday between the hours of 9 AM – 7 PM EST, with the ability to adjust shifts based on business needs.