Entry-Level Customer Service Representative – Claims & Member Support Specialist at brighthush (Pennsylvania Resident)

About brighthush

brighthush is a forward‑thinking health system that has been transforming patient care for over a century. With a network of hospitals, a robust health plan, cutting‑edge research centers, and a dedicated medical school, brighthush is committed to delivering high‑quality, compassionate care to communities across Pennsylvania and beyond. Our mission is simple yet powerful: make better health easier for everyone. We do this by fostering a culture of kindness, excellence, learning, innovation, and safety—values that guide every interaction, every decision, and every innovation we bring to the table.

Role Overview

As an Entry‑Level Customer Service Representative – Claims & Member Support Specialist, you will be the frontline champion for our members and providers. Your primary focus will be to resolve claims inquiries, ensure accurate benefit coverage, and maintain the highest level of customer satisfaction. You will work closely with cross‑functional teams, participate in continuous process improvement initiatives, and contribute to a collaborative, high‑performing environment that values every voice.

Key Responsibilities

• Claims Resolution: Review and analyze suspended or disputed claims, applying current policies, procedures, and benefit guidelines to determine coverage eligibility.
• Member & Provider Support: Provide daily assistance and expert guidance to members and provider staff on claims issues, ensuring clear communication and timely resolution.
• Process Improvement: Actively participate in cross‑training and process‑enhancement projects to streamline claims workflows and reduce turnaround times.
• Team Collaboration: Share best practices and training resources with peers, fostering a culture of continuous learning and mutual support.
• Data Accuracy: Maintain meticulous records of claim investigations, decisions, and communications in our enterprise systems.
• Compliance & Quality: Adhere to all internal policies, regulatory requirements, and quality standards to protect member privacy and data integrity.

Essential Qualifications

• High school diploma or GED (required). A college degree or relevant coursework is a plus.
• Minimum of one (1) year of customer service experience, preferably in a healthcare or insurance environment.
• Strong verbal and written communication skills, with the ability to explain complex policies in simple terms.
• Demonstrated ability to handle high‑volume, high‑stress situations while maintaining a calm, professional demeanor.
• Proficiency with Microsoft Office Suite (Word, Excel, Outlook) and experience navigating enterprise customer‑service platforms.
• Basic understanding of health insurance terminology and claims processes.

Preferred Qualifications

• Experience working with claims management systems such as ClaimsCenter or Medisoft.
• Knowledge of Pennsylvania state insurance regulations and federal compliance requirements.
• Previous exposure to cross‑functional teams (e.g., underwriting, provider relations, member services).
• Demonstrated commitment to continuous improvement, such as participation in Kaizen or Six Sigma projects.
• Fluency in a second language (Spanish, French, or other) is an asset for serving diverse member populations.

Skills & Competencies

• Customer‑Centric Mindset: Passion for delivering exceptional service and building lasting relationships.
• Analytical Thinking: Ability to dissect complex claims scenarios and apply policy logic accurately.
• Problem‑Solving: Creative, solution‑oriented approach to resolving member and provider concerns.
• Collaboration: Comfortable working in a team environment and sharing knowledge with peers.
• Adaptability: Thrives in a fast‑changing environment and embraces new technologies and processes.
• Attention to Detail: Consistently ensures data accuracy and compliance with regulatory standards.

Career Growth & Learning Opportunities

At brighthush, we believe that every employee’s growth fuels our collective success. As a member of our Customer Service team, you will:

• Participate in structured onboarding and ongoing training programs that cover claims management, regulatory compliance, and customer‑service excellence.
• Earn certifications such as Certified Claims Specialist (CCS) or Health Insurance Associate (HIA) through our partnership with industry bodies.
• Progress into senior roles such as Claims Analyst, Team Lead, or Member Experience Manager, with clear pathways and mentorship support.
• Engage in cross‑departmental projects that expose you to underwriting, provider relations, and data analytics.
• Attend quarterly innovation workshops where you can propose and pilot new ideas to improve member experience.

Work Environment & Company Culture

brighthush is built on a foundation of kindness, excellence, learning, innovation, and safety. Our workplace is:

• Collaborative: Open communication channels, regular team huddles, and a culture that values every voice.
• Inclusive: A diverse workforce that reflects the communities we serve, fostering empathy and understanding.
• Supportive: Comprehensive onboarding, mentorship programs, and a dedicated HR team that champions employee well‑being.
• Dynamic: Continuous improvement initiatives, technology adoption, and a focus on delivering measurable impact.
• Flexible: Hybrid work options and flexible scheduling to support work‑life balance.

Compensation & Benefits

While specific figures vary by role and location, brighthush offers a competitive compensation package that includes:

• Base salary commensurate with experience and market benchmarks.
• Performance‑based bonuses and incentive programs.
• Comprehensive health benefits (medical, dental, vision) from day one.
• Prescription coverage and wellness programs.
• Retirement savings plan with employer match.
• Paid time off, holidays, and flexible leave policies.
• Employee assistance programs, mental health resources, and continuous learning stipends.

How to Apply

If you are passionate about helping people, thrive in a fast‑paced environment, and want to make a tangible difference in the lives of our members and providers, we encourage you to apply today. Submit your resume and a brief cover letter outlining why you’re the ideal fit for this role.

Closing Statement

At brighthush, you’ll join a team that is dedicated to transforming health care through compassion, innovation, and relentless pursuit of excellence. Your work as a Customer Service Representative – Claims & Member Support Specialist will directly impact the quality of care our members receive and the efficiency of our provider network. If you’re ready to grow, learn, and contribute to a culture that values every individual, we can’t wait to meet you.