Customer Service Representative I – Claims Support (Remote, Pennsylvania) – Member & Provider Advocacy, Process Improvement, and Team Collaboration

About brighthush

At brighthush, we are dedicated to delivering compassionate, high‑quality care and support to the communities we serve. As a leading health plan provider, our mission is to empower members, providers, and employees alike through innovative solutions, relentless focus on safety, and a culture built on kindness, excellence, learning, and innovation. Our remote workforce is a vital part of this mission, and we are proud to offer flexible, work‑from‑home opportunities that enable our team members to thrive both professionally and personally.

Why This Role Matters

The Customer Service Representative I – Claims position is a cornerstone of brighthush’s commitment to member satisfaction and provider partnership. By expertly navigating claims inquiries, resolving issues, and educating stakeholders, you will directly influence the health and financial well‑being of our members while upholding the integrity of our claims processes. This role also offers a unique platform for cross‑training, continuous improvement, and career growth within a supportive, collaborative environment.

Key Responsibilities

• Claims Eligibility & Coverage Determination: Review incoming service requests and determine whether they are covered under the applicable line of business and product design.
• Suspend & Resolve Claims: Analyze suspended claims, apply current policies, procedures, and benefit guidelines, and work toward timely resolution.
• Team Resource Development: Create and share resources that guide peers on proper claims resolution policies, fostering a knowledgeable and self‑sufficient team.
• Member & Provider Support: Provide daily advice and assistance to member and provider services staff, acting as a trusted subject‑matter expert on claims issues.
• Research & Reconsideration: Investigate claim discrepancies reported by providers, identify criteria for payment reconsideration, and communicate findings clearly.
• Process Improvement: Actively participate in cross‑training initiatives and suggest enhancements to streamline the claims workflow.
• Compliance & Documentation: Ensure all actions comply with brighthush policies, federal and state regulations, and maintain accurate documentation for audit readiness.

Essential Qualifications

• High School Diploma or GED (required).
• Minimum of 1 year of customer service experience, preferably in a health‑care or insurance setting.
• Demonstrated ability to communicate clearly, both verbally and in writing, with diverse audiences.
• Strong problem‑solving skills and a keen eye for detail when reviewing claims data.
• Proficiency with standard office software (Microsoft Office Suite, email platforms) and comfort navigating web‑based claim management systems.

Preferred Qualifications & Additional Skills

• Previous experience in health‑care claims processing or a related field.
• Familiarity with health‑care terminology, insurance products, and regulatory guidelines (e.g., HIPAA, ACA).
• Experience working remotely, including self‑discipline, time‑management, and a reliable home office setup.
• Certification in Customer Service Excellence or a related professional credential.
• Ability to multitask, prioritize competing demands, and maintain composure under pressure.

Core Skills & Competencies

• Communication: Articulate complex claims information in an understandable manner for members, providers, and internal teams.
• Customer Retention: Employ empathy and active listening to resolve concerns, turning challenging interactions into positive experiences.
• Analytical Thinking: Evaluate claim details, identify patterns, and recommend corrective actions.
• Team Collaboration: Share knowledge, mentor peers, and contribute to a culture of continuous learning.
• Adaptability: Embrace evolving policies, technology updates, and shifting workload demands.

Career Growth & Learning Opportunities

brighthush invests heavily in the professional development of its employees. As a Customer Service Representative I – Claims, you will have access to:

• Structured onboarding and ongoing training programs that cover claims fundamentals, advanced policy interpretation, and customer experience best practices.
• Mentorship from senior claims analysts and managers, providing a clear pathway toward higher‑level positions such as Claims Analyst, Senior Representative, or Team Lead.
• Internal tuition reimbursement and certification support for industry‑recognized credentials (e.g., Certified Professional in Healthcare Quality, CPHQ).
• Opportunities to participate in cross‑functional projects, process‑improvement task forces, and innovation labs that shape the future of brighthush’s claims operations.

Work Environment & Culture at brighthush

Our remote workforce enjoys a flexible, results‑oriented environment that values work‑life balance. Key cultural pillars include:

• Kindness: We treat every colleague, member, and provider with the respect and empathy we wish to receive.
• Excellence: High standards are celebrated, and continuous improvement is encouraged.
• Learning: Knowledge sharing is a daily habit; we provide resources, webinars, and peer‑learning circles.
• Innovation: Employees are empowered to suggest new tools, processes, and ideas that enhance member experience.
• Safety: Even in a virtual setting, we prioritize data security, mental‑health resources, and ergonomic best practices.

Compensation, Perks, & Benefits

brighthush offers a competitive total rewards package designed to support your health, financial security, and overall well‑being:

• Competitive Salary: Aligned with industry standards for remote customer service roles.
• Comprehensive Health Benefits: Medical, dental, vision, and prescription coverage available from day one for full‑time employees.
• Flexible Spending Accounts (FSAs) & Health Savings Accounts (HSAs): To help manage out‑of‑pocket expenses.
• Retirement Savings: 401(k) plan with company matching contributions.
• Paid Time Off (PTO): Generous vacation, sick leave, and holidays to recharge.
• Remote Work Stipend: Assistance for home‑office equipment, internet, and ergonomic accessories.
• Employee Assistance Program (EAP): Confidential counseling, legal, and financial guidance.
• Learning & Development: Access to online courses, webinars, and a library of industry resources.
• Recognition Programs: Awards and incentives for outstanding performance and innovative ideas.

Equal Opportunity Commitment

brighthush is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, veteran status, or any other protected characteristic.

How to Apply

If you are passionate about delivering exceptional service, enjoy solving complex claims challenges, and thrive in a collaborative remote environment, we invite you to join the brighthush family. Click the link below to submit your application and begin your journey with a company that truly cares about its people and the communities it serves.