Eligibility Service Representative - Mandarin/Cantonese

Brighton Health Plan Solutions (BHPS) is seeking an Eligibility Service Representative (ESR) 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 serves as the client’s eligibility vendor, forwarding eligibility files to health plans, dental vendors, and other client-utilized vendors. The ESR will confirm, identify, and research matters related to eligibility, changes to coverage and participation, and support the Eligibility & Benefits team.

Responsibilities

• Receive and resolve caregiver inquiries.
• Work with the Benefits Enrollment team to review and resolve 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 and analysis, and issue resolution.
• Clarify customer requirements; probe for and confirm understanding of requirements or problems.
• Manage caregiver requests within required turnaround time, including conducting outreach to internal partners and 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.
• Apply critical thinking to solve complex problems and identify when to escalate to the appropriate department.
• Perform call center functions, including handling inbound calls and supporting projects as directed by management.
• Maintain broad knowledge of client requirements, procedures, and key contacts.
• Support projects and other departments in completing tasks when directed by management.

Requirements

• Bilingual in Russian/English or Korean/English.
• Flexible availability for alternate schedules/hours, including shifts between 11 AM and 9 PM EST, Monday through Friday, with training from 9 AM to 6 PM.
• Experience in high-volume enrollment and eligibility transactions, premium billing, and collections.
• Knowledge of labor and commercial carrier enrollment procedures.
• Prior high-volume call center experience.
• General knowledge of HIPAA confidentiality.
• High School diploma or GED.
• Remote work capability with internet access.
• Basic computer skills, including Microsoft Office (Word, Excel, Access, PowerPoint, Outlook).
• Strong investigative and time management skills.
• Courteous and customer-service oriented.
• Detail-oriented and dependable.
• Effective communication through multiple channels (email, chat, voice).

Qualifications

• Preferred experience in enrollment/eligibility roles, especially in commercial and labor plans.
• Previous multi-channel experience (voice, email, chat) is a plus.
• Some college or business school education is advantageous.

About Brighton Health Plan Solutions

At Brighton Health Plan Solutions, LLC, our people are committed to improving 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, and other TPAs, enabling them to solve today’s healthcare challenges with flexible and cutting-edge third-party administration services. Our unique perspective stems 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.

Pay

Annual Salary Range: $43,000 - $50,000. The salary range and/or hourly rate listed is a good faith determination that may be offered to a successful applicant for this position at the time of posting and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable by law, including but not limited to location, years of relevant experience, education, credentials, skills, budget, and internal equity.

Schedule

• Flexible availability for alternate schedules/hours, including shifts between 11 AM and 9 PM EST, Monday through Friday.
• Training from 9 AM to 6 PM.