Customer Service Agent II – Remote Healthcare Claims Support & Inbound Call Center Specialist at brighthush

Why Join brighthush?

At brighthush, we are redefining the future of health‑insurance technology with an AI‑driven operational platform that gives insurers a lasting financial advantage. Our solutions empower health plans to modernize core processes, improve member experiences, and stay ahead in a fiercely competitive market. As the industry accelerates toward digital transformation, brighthush is experiencing unprecedented growth, and we are investing heavily in the talent that fuels that momentum. This is a unique moment to become part of a forward‑thinking organization that values innovation, collaboration, and the personal development of every team member.

Position Overview

The Customer Service Agent II will be a pivotal member of brighthush’s U.S. Customer Service team, delivering top‑tier support to our health‑plan partners and their members. Reporting directly to the Customer Service Manager, you will handle inbound and outbound calls, manage ticketing workflows, and act as a critical liaison between claims departments, providers, and customers. The role is fully remote, offering flexibility while still requiring collaboration across multiple time zones.

Key Responsibilities

• Inbound Call Management: Answer high‑volume inbound calls, provide accurate information, and resolve member inquiries with professionalism and empathy.
• Outbound Outreach: Initiate outbound calls when required, following up on pending issues, gathering additional information, or confirming claim resolutions.
• Ticket Documentation: Accurately log every interaction in brighthush’s ticketing and tracking systems, ensuring a clear audit trail and timely escalation when needed.
• Data Provision: Retrieve and deliver claim data, benefit details, and plan information to customers within established service level agreements.
• Liaison Role: Serve as the communication bridge between the claims department, healthcare providers, and members, facilitating smooth information flow.
• Claims Research: Investigate member claims using primary payer systems, verify coverage, and clarify benefit eligibility.
• Quality Assurance: Consistently uphold the highest standards of customer service on every call, adhering to brighthush’s quality metrics and compliance guidelines.
• Continuous Improvement: Identify recurring issues, suggest process enhancements, and contribute to knowledge‑base updates.
• Additional Duties: Perform other related tasks as assigned, supporting the broader goals of the Customer Service department.

Essential Qualifications

• High school diploma or equivalent (GED accepted).
• 2–3 years of experience in healthcare claims operations, medical billing, or a high‑volume call‑center environment.
• Demonstrated knowledge of Medicare and Medicare Advantage plans is highly desirable.
• Strong grasp of covered plan benefits and the ability to explain them clearly to members.
• Excellent verbal and written communication skills, with a focus on active listening and clear articulation.
• Exceptional attention to detail, analytical thinking, and problem‑solving abilities.
• Proficiency with Microsoft Office, especially Word and Excel; familiarity with ticketing platforms (e.g., ServiceNow, Zendesk) is a plus.

Preferred Qualifications & Additional Skills

• Associate’s or Bachelor’s degree in Health Administration, Business, or a related field.
• Certification such as Certified Professional Coder (CPC) or Certified Medical Reimbursement Specialist (CMRS).
• Experience with electronic health record (EHR) systems or payer portals.
• Ability to work flexible schedules, including evenings (up to 9 pm EST) to support our extended service window.
• Demonstrated ability to thrive in a remote, hybrid, or distributed work environment.
• Comfort with handling confidential health information in compliance with HIPAA and other privacy regulations.

Core Skills & Competencies

• Customer‑Centric Mindset: Passion for delivering an outstanding member experience.
• Communication Excellence: Clear, concise, and courteous interaction with diverse audiences.
• Technical Aptitude: Quick learner of new software tools, claim‑processing platforms, and AI‑driven analytics dashboards.
• Time Management: Ability to prioritize multiple tasks while meeting strict response time targets.
• Team Collaboration: Strong partnership skills with claims, provider relations, and IT teams.
• Adaptability: Comfortable navigating a fast‑changing regulatory and technology landscape.

Work Environment & Culture at brighthush

brighthush embraces a modern, inclusive, and flexible work culture. Our remote workforce enjoys:

• State‑of‑the‑art collaboration tools (Slack, Microsoft Teams, Zoom) that keep you connected to teammates across the country.
• A results‑oriented performance model that values output over hours logged.
• Regular virtual team‑building events, wellness challenges, and professional development webinars.
• Commitment to diversity, equity, and inclusion—brighthush actively recruits and supports veterans, people with disabilities, women, and under‑represented minorities.
• Ergonomic support for home offices, including stipends for equipment, high‑speed internet, and optional coworking‑space memberships.

Compensation, Benefits & Perks

While the exact hourly rate will be determined during the interview process, the advertised range is $18–$21 per hour, reflecting experience and skill level. In addition to competitive pay, brighthush offers a comprehensive benefits package that may include:

• Medical, dental, and vision insurance with multiple plan options.
• 401(k) retirement plan with company match.
• Paid time off (PTO), sick leave, and paid holidays.
• Life and short‑term disability coverage.
• Employee Assistance Program (EAP) for mental health and personal counseling.
• Continuous learning budget for certifications, courses, and conferences.
• Performance‑based bonuses and recognition programs.

Career Growth & Development Opportunities

At brighthush, your career trajectory is limited only by your ambition. As a Customer Service Agent II, you will have pathways to:

• Advance to senior or lead customer service roles, overseeing a team of agents.
• Transition into specialized claims analysis, provider relations, or operations management.
• Participate in cross‑functional projects that influence product development and AI model training.
• Earn industry‑recognized certifications (e.g., Certified Professional in Healthcare Quality, Certified Claims Analyst).
• Access mentorship programs that pair you with senior leaders in the organization.

Physical & Logistical Requirements

This role is remote, but candidates must be able to meet the following physical and logistical expectations:

• Occasional movement around a home office to set up equipment or retrieve documents.
• Visual acuity for close‑up work on computer screens, color differentiation, and depth perception.
• Extended periods of sitting while using a computer, headset, and video conferencing tools.
• Reliable high‑speed internet connection and a quiet workspace conducive to professional calls.
• Potential travel for occasional in‑person training sessions or company events, as business needs dictate.

Equal Opportunity & Inclusion

brighthush is an equal‑opportunity employer. We celebrate diversity and are committed to building a workforce that reflects the communities we serve. All qualified applicants—including racial and ethnic minorities, women, veterans, and individuals with disabilities—are encouraged to apply. Reasonable accommodations are available for candidates with disabilities throughout the recruitment process.

Application Process

If you are ready to bring your expertise in healthcare claims and customer service to a dynamic, technology‑driven environment, we want to hear from you. To apply, click the link below, submit your resume, and include a brief cover letter highlighting your most relevant experience.

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Take the Next Step

Joining brighthush means becoming part of a mission‑focused team that is shaping the future of health‑insurance operations. Your voice will matter, your growth will be supported, and your contributions will directly impact the lives of millions of members across the United States. Don’t miss this chance to advance your career while making a meaningful difference. Apply today and start your journey with brighthush!