Customer Service Representative/ Bilingual (Spanish)

Brighton Health Plan Solutions, LLC is transforming the health plan experience by delivering outstanding products and services to partners. We enable self-insured employers, Taft-Hartley Trusts, health systems, providers, and other TPAs to solve today’s healthcare challenges with flexible, cutting-edge third-party administration services. Our culture values diversity, inclusion, and belonging, encouraging every team member to bring their authentic self to work.

About the role

The Customer Service Representative, Bilingual, assists members, physicians, hospitals, revenue agencies, and other healthcare providers with member benefits, eligibility, claims inquiries, claim reconsiderations, and appeals.

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, appeals, and call center responsibilities.
• Previous experience in a physician’s office, group practice, clinic, or hospital-based practices.
• High School diploma; 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.

Schedule

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

Pay

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 at the time of posting and may be modified in the future. Factors considered include location, years of relevant experience, education, credentials, skills, budget, and internal equity.