Eligibility Service Representative - Mandarin/Cantonese

About the role

Brighton Health Plan Solutions (BHPS) is seeking an Eligibility Service Representative (ESR) who are experienced in understanding eligibility, communicating through various multi-channel features such as phone, chat and email, and following workflows to assist in issue resolution. BHPS shall serve as the client’s eligibility vendor and forward eligibility files to health plans, dental vendors and any other vendor the client utilizes. The ESR will confirm, identify and research matters as they relate to eligibility, changes to coverage and participation as well as support the Eligibility & Benefits team.

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.

Responsibilities

• Receive and resolve caregiver inquiries.
• Work with the Benefits Enrollment team to review and resolve any eligibility, hours or co-premium issues including follow-up outreach to caregivers.
• Listen attentively to customer needs and concerns; demonstrate empathy and offer solutions.
• Demonstrate strong customer service skills, attention to detail, research & analyzation and issue resolution.
• Clarify customer requirements; probe for and confirm understanding of requirements or problem.
• Manage caregiver requests within required turnaround time including conducting outreach to internal partners, engaging the support of the Team Leader and Supervisor as necessary.
• Communicate effectively with individuals/teams to ensure high quality and timely expedition of customer requests.
• Participate in activities designed to improve customer satisfaction and business performance.
• Use decision-support tools to answer questions, where needed.
• Ability to use critical thinking to solve complex problems and identify when to escalate to the appropriate department.
• Perform call center functions including handling inbound