Customer Care Representative I – Virtual Insurance Benefits & Claims Support Specialist for brighthush

About brighthush

brighthush is a leading health‑focused organization dedicated to simplifying healthcare and improving the lives of members and communities across the nation. As a Fortune 25 company with deep roots in the industry, brighthush combines innovative technology, compassionate service, and a relentless commitment to health equity. Our mission is to make healthcare more accessible, understandable, and personalized for every individual we serve.

Why This Role Matters

As a Customer Care Representative I at brighthush, you will be the first point of contact for members, providers, and internal partners seeking clear, accurate information about insurance benefits, eligibility, claims, and provider contracts. Your ability to listen, analyze, and resolve inquiries will directly impact member satisfaction, operational efficiency, and the overall reputation of brighthush as a trusted health partner.

Position Overview

This is a fully virtual, full‑time position that offers maximum flexibility while still providing essential in‑person training sessions to ensure you are equipped with the skills and knowledge needed for success. You will work from a home office, but you must reside within a reasonable commuting distance to a brighthush office for occasional on‑site requirements, such as training, team meetings, or collaborative workshops.

Key Responsibilities

• Respond promptly to internal and external customer inquiries via telephone, email, chat, and fax regarding insurance benefits, provider contracts, eligibility, and claims status.
• Analyze each inquiry, identify root causes, and deliver accurate, solution‑focused information while adhering to brighthush policies and regulatory guidelines.
• Utilize brighthush’s PC/image station and proprietary databases to retrieve, verify, and document member and provider information.
• Maintain meticulous records of all interactions, outcomes, and follow‑up actions in the customer relationship management (CRM) system to support tracking, reporting, and continuous improvement.
• Develop and nurture positive relationships with members, providers, and internal stakeholders, ensuring that each interaction reflects brighthush’s commitment to empathy and professionalism.
• Conduct outbound outreach within the ZipDrug business area to verify information, gather feedback, and proactively address potential issues.
• Multi‑task across phone calls, text messages, emails, and electronic queues while taking detailed notes and delivering consistent, high‑quality service.
• Collaborate with specialists, managers, and cross‑functional teams to escalate non‑basic issues and follow through on resolutions.
• Leverage digital tools and automation platforms to streamline workflows, reduce manual effort, and increase overall productivity.
• Adhere to a structured schedule, including occasional overtime or flexible hours based on business demand, and attend required in‑person sessions at a brighthush office.
• Participate in ongoing training, quality assurance reviews, and performance feedback sessions to continuously improve service delivery.
• Perform additional duties as assigned, contributing to team goals and organizational success.

Minimum Qualifications

• High school diploma or equivalent (GED) required.
• Prior experience in an automated customer service environment, preferably within health insurance, benefits administration, or a related field.
• Demonstrated ability to pass a pre‑employment test battery assessing basic technical and communication competencies.
• Proficiency with standard office software (Microsoft Office Suite, email platforms, web browsers) and comfort navigating multiple digital systems simultaneously.
• Strong written and verbal communication skills, with the ability to convey complex information in a clear, concise manner.
• Reliable high‑speed internet connection and a suitable home office setup that meets brighthush’s virtual work standards.

Preferred Skills, Capabilities, and Experiences

• Oral and written communication: Ability to articulate information clearly and empathetically across multiple channels.
• Problem‑solving: Proven track record of diagnosing issues, researching solutions, and delivering outcomes that satisfy customers.
• Facilitation: Experience guiding conversations, gathering necessary details, and steering interactions toward resolution.
• Analytical mindset: Comfort interpreting data, recognizing patterns, and recommending process improvements.
• Technical aptitude: Familiarity with CRM platforms, ticketing systems, and basic troubleshooting of digital tools.
• Experience in a fast‑paced, high‑pressure environment where multitasking and attention to detail are essential.
• Demonstrated empathy, patience, and persistence when handling complex or emotionally charged customer situations.

Core Skills & Competencies

• Customer‑centric focus: Prioritizing member needs and delivering service that exceeds expectations.
• Critical thinking: Quickly assessing information, identifying gaps, and formulating effective solutions.
• Time management: Balancing multiple inquiries and tasks while meeting service level agreements (SLAs).
• Collaboration: Working seamlessly with cross‑functional teams, sharing knowledge, and supporting collective goals.
• Adaptability: Thriving in a dynamic environment with evolving policies, technology updates, and regulatory changes.
• Digital fluency: Leveraging automation, chatbots, and self‑service portals to enhance efficiency.

Work Environment & Culture at brighthush

brighthush fosters a culture of inclusion, continuous learning, and purposeful impact. Our virtual workforce model is built on trust, autonomy, and clear communication. While you will primarily work from home, you will be part of a vibrant community that values:

• Collaboration: Regular virtual huddles, mentorship programs, and cross‑departmental projects.
• Well‑being: Access to wellness resources, mental‑health support, and flexible scheduling to promote work‑life integration.
• Diversity & Inclusion: A commitment to creating an environment where every voice is heard and respected.
• Recognition: Performance‑based incentives, peer‑to‑peer recognition platforms, and career‑advancement pathways.

Compensation, Perks, & Benefits

brighthush offers a competitive total rewards package designed to support your financial security, health, and personal growth. While exact figures will be discussed during the interview process, you can expect:

• Market‑aligned base salary with regular merit increases.
• Performance‑based incentive bonuses.
• Comprehensive medical, dental, and vision coverage for you and eligible dependents.
• Short‑ and long‑term disability insurance.
• Life insurance and accidental death & dismemberment coverage.
• 401(k) plan with company match and a stock purchase program.
• Paid time off (PTO), paid holidays, and flexible paid leave options.
• Wellness programs, including virtual fitness classes, mental‑health resources, and nutrition counseling.
• Professional development stipends for certifications, courses, and conferences.
• Access to a robust employee assistance program (EAP) for personal and professional challenges.

Career Growth & Learning Opportunities

At brighthush, your career trajectory is shaped by your ambition and the support you receive. As a Customer Care Representative I, you will have access to:

• Structured onboarding and continuous training modules covering insurance fundamentals, compliance, and advanced customer service techniques.
• Mentorship from senior customer experience leaders and subject‑matter experts.
• Clear pathways to advance into Customer Care Representative II, Team Lead, Quality Analyst, or specialized roles in claims processing, provider relations, or member services.
• Opportunities to participate in cross‑functional projects that influence product development, process improvement, and digital transformation initiatives.
• Regular performance reviews that identify skill gaps and create personalized development plans.

Commitment to Safety & Compliance

brighthush prioritizes the health and safety of its associates and members. All new hires for member‑facing roles must be vaccinated against COVID‑19 and influenza, unless a legally acceptable exemption is provided. We also adhere strictly to federal, state, and local regulations governing employment, data privacy, and healthcare compliance.

Equal Opportunity & Accessibility

brighthush is an Equal Employment Opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees, regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected characteristic. If you require a reasonable accommodation to participate in the application process, please let us know, and we will work with you to ensure a smooth experience.

How to Apply

If you are ready to join a forward‑thinking health organization where your voice matters and your contributions directly improve the lives of millions, we encourage you to submit your application today. Bring your passion for service, your analytical mindset, and your desire to grow within a supportive, innovative environment.

Take the next step in your career—apply now and become a vital part of brighthush’s mission to make healthcare simpler and more compassionate for everyone.