Brighton Health Plan Solutions Is Hiring A Customer Service Representative/ Bilingual (English/Spanish)

Join Brighton Health Plan Solutions as a Bilingual Customer Service Representative and play a vital role in supporting members and healthcare providers while making a positive impact on the healthcare experience. 🌟

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. This position requires flexibility to work various shifts from Monday to Friday between 9 AM – 7 PM EST. Shift adjustments may be needed based on business needs, with notice provided.

Please note that this job description does not encompass all activities and responsibilities; duties may change or be added at any time without notice.

Primary Responsibilities

• Handle inbound calls from members, medical providers, and other stakeholders 📞
• Adjust claims accurately when necessary 📝
• Listen empathetically to and address customer needs and concerns 💬
• Respond to questions about fee schedules, network participation, and requirements
• Aim for first contact resolution whenever possible 🎯
• Update customer files and communicate effectively with team members
• Redirect misdirected requests and offer solutions for non-routine issues
• Contribute to customer satisfaction and ongoing business improvements
• Use decision-support tools to ensure accurate responses
• Investigate inquiries using training and systems 🧠
• Tailor responses based on caller understanding
• Educate callers and confirm their understanding 🤝
• Support projects and assist other departments as directed by management

Essential Qualifications

The ideal candidate has experience in a high-volume call center environment, familiarity with claims inquiry and review procedures, and knowledge of medical specialties, fee schedules, complaints, and appeals. Prior experience in a physician’s office, group practice, clinic, or hospital setting is preferred.

• High school diploma; some college or business school education is a plus 🎓
• Fluent in both Spanish and English 🗣️
• Basic computer operation skills 💻
• Intermediate proficiency in Microsoft Office (Word, Excel, Access, PowerPoint, Outlook)
• Strong time management skills ⏱️
• Understanding of HIPAA confidentiality laws 🔐
• Quick learner capable of grasping managed care procedures and claims payment policies
• Detail-oriented, dependable, and with effective listening and responding skills
• Flexible, adaptable, and capable of conceptual thinking 🌐
• Strong problem-solving skills 🧩
• Excellent attendance and punctuality ✅
• Comfortable performing tasks at a computer and telephone station
• Effective communicator across multiple channels including email, chat, and voice 📧📞💬
• Experience with multi-channel communication is a plus

About Brighton Health Plan Solutions

At Brighton Health Plan Solutions, LLC, our team is dedicated to improving how healthcare is accessed and delivered. We foster a diverse and inclusive culture where everyone is encouraged to bring their authentic selves and unique abilities to work. 🌍

We collaborate with self-insured employers, Taft-Hartley Trusts, health systems, providers, TPAs, and more, utilizing our health plan management expertise, proprietary networks, and innovative technology to transform the healthcare experience. Our goal is to empower clients with customizable tools to enhance member satisfaction, improve health outcomes, and realize their healthcare objectives.

Join us to be a part of The Brightest Ideas in Healthcare™.

Company Mission

Transform the health plan experience by bringing outstanding products and services to our partners. 🚀

Company Vision

Redefine healthcare quality and value by aligning incentives in innovative and impactful ways.

DEI Purpose Statement

We promote an environment where all team members can bring their authentic selves, respecting diverse perspectives and fostering a culture of inclusion and belonging at every level. 🌈

We are an Equal Opportunity Employer

Compensation & Additional Details

Annual Salary Range: $45,760 - $47,840 💵

This range is a good faith estimate and may be adjusted based on factors such as location, experience, education, skills, and internal equity.

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