The Customer Service Representative assists members, physicians, hospitals, revenue agencies and other healthcare providers with member benefits, eligibility, claims inquiry, claim reconsiderations and appeals. The Customer Service Representatives must be able to work in various shifts Monday to Friday between the hours of 9AM – 7PM EST with the ability to adjust shifts with notice based on business needs.
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities and activities may change, or new ones may be assigned at any time with or without notice.
Primary 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
Essential Qualifications
The successful candidate will have experience in a high-volume call center, experience with claims inquiry and claims review procedures, knowledge of medical specialties, fee schedules, complaints and appeals and call center responsibilities. Previous experience in a physician’s office, group practice, clinic or hospital-based practices.
High School diploma with 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
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.
Come be a part of the Brightest Ideas in Healthcare™.
Company Mission
Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.
Company Vision
Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.
DEI Purpose Statement
At BHPS, we encourage all team members to bring your authentic selves to work with all of your unique abilities. We respect how you experience the world and welcome you to bring the fullness of your lived experience into the workplace. We are building, nurturing and embracing a culture focused on increasing diversity, inclusion and a sense of belonging at every level.
We are an Equal Opportunity Employer
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 for this position at the time of the posting of an advertisement 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.
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Seniority level
Entry level
Employment type
Full-time
Job function
Other
Industries
Internet Publishing
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