Entry-Level Customer Service Representative – Claims Specialist for Pennsylvania Residents at brighthush

About brighthush

brighthush is a leading health‑care benefits provider dedicated to delivering exceptional service and innovative solutions to members and providers across Pennsylvania. With a mission to simplify access to quality care, brighthush has built a reputation for integrity, transparency, and a relentless focus on customer satisfaction. Our team of passionate professionals works collaboratively to resolve complex claims, streamline processes, and empower patients to navigate their health journeys with confidence.

At brighthush, we believe that every interaction matters. Whether you’re helping a member understand a claim, supporting a provider with billing questions, or collaborating with internal teams to improve service delivery, your work directly impacts the health and well‑being of thousands of people. Join us and become part of a culture that values innovation, continuous learning, and a genuine commitment to community health.

Role Overview

We are seeking an enthusiastic, detail‑oriented Entry‑Level Customer Service Representative – Claims Specialist to join our remote Pennsylvania team. In this role, you will be the first point of contact for members and providers who need assistance with claims, ensuring that concerns are resolved efficiently and accurately. You will work closely with cross‑functional teams, including underwriting, billing, and compliance, to review suspended claims, investigate discrepancies, and provide timely, accurate information.

As a remote employee, you will enjoy the flexibility of working from home while remaining an integral part of a collaborative, high‑performing team. This full‑time position offers a structured onboarding program, ongoing training, and a clear path for career advancement within brighthush.

Key Responsibilities

• Customer Interaction: Serve as the primary point of contact for members and providers, addressing inquiries related to claims status, coverage, and payment.
• Claims Review: Examine suspended or disputed claims, identify root causes, and recommend appropriate actions to resolve issues.
• Issue Research: Conduct thorough investigations into claim discrepancies, collaborating with internal stakeholders to gather necessary documentation.
• Documentation & Reporting: Accurately document all interactions, decisions, and follow‑up actions in the customer relationship management (CRM) system.
• Process Improvement: Identify recurring patterns or bottlenecks in the claims process and propose solutions to enhance efficiency and customer satisfaction.
• Compliance & Quality Assurance: Adhere to all regulatory requirements, company policies, and quality standards in every customer interaction.
• Team Collaboration: Participate in regular team meetings, knowledge‑sharing sessions, and training workshops to stay current on product updates and industry trends.

Essential Qualifications

• High school diploma or GED (or equivalent).
• Minimum of 1 year of customer service experience, preferably in a call center or health‑care environment.
• Strong verbal and written communication skills in English.
• Proficiency with computers and experience using customer service or CRM software.
• Ability to work independently in a remote setting, managing time effectively and meeting performance metrics.
• Basic understanding of health‑care claims processes and terminology is a plus.

Preferred Qualifications

• Experience in a health‑care claims or billing role.
• Knowledge of Pennsylvania health‑care regulations and provider networks.
• Familiarity with data analysis tools (Excel, Power BI) for tracking claim trends.
• Previous remote work experience with a proven track record of meeting or exceeding KPIs.
• Certification in customer service or health‑care administration (e.g., Certified Customer Service Professional).

Skills & Competencies

• Problem‑Solving: Ability to analyze complex claim issues and develop effective solutions.
• Attention to Detail: Meticulous in reviewing documentation and ensuring accuracy.
• Empathy & Patience: Demonstrated skill in handling sensitive or frustrated customers with professionalism.
• Time Management: Efficiently prioritize tasks to meet daily call volume and resolution targets.
• Adaptability: Comfortable navigating changing processes, policies, and technology platforms.
• Team Player: Willingness to collaborate with colleagues across departments to achieve shared goals.

Career Growth & Learning Opportunities

At brighthush, we invest heavily in the professional development of our team members. As a Customer Service Representative – Claims Specialist, you will have access to:

• Structured onboarding and mentorship programs to accelerate your learning curve.
• Regular training sessions on the latest health‑care regulations, claim management tools, and customer service best practices.
• Opportunities to cross‑train in related areas such as underwriting, billing, or compliance.
• A clear career ladder that includes roles such as Senior Claims Specialist, Claims Analyst, or Team Lead.
• Access to industry conferences, webinars, and certification courses funded by brighthush.

Work Environment & Company Culture

Working remotely from Pennsylvania, you will be part of a vibrant, inclusive culture that values work‑life balance and continuous improvement. Our remote team enjoys:

• Flexible scheduling within core business hours to accommodate personal commitments.
• Regular virtual team‑building events, wellness challenges, and community outreach initiatives.
• A collaborative platform that encourages knowledge sharing and peer support.
• Recognition programs that celebrate individual and team achievements.

Compensation, Perks, and Benefits

While specific figures may vary based on experience and location, brighthush offers a competitive compensation package that includes:

• Base salary commensurate with industry standards for entry‑level claims specialists.
• Performance‑based bonuses tied to customer satisfaction scores and resolution metrics.
• Comprehensive health, dental, and vision insurance plans.
• 401(k) retirement plan with company match.
• Paid time off, including vacation, sick leave, and holidays.
• Professional development stipend and tuition reimbursement for relevant courses.
• Employee assistance program and mental health resources.
• Access to a virtual wellness portal with fitness, mindfulness, and nutrition tools.

How to Apply

Ready to make a difference in the lives of Pennsylvania residents and providers? Submit your application through our careers portal by clicking the link below. We look forward to learning how your skills and passion align with brighthush’s mission.

Apply to brighthush Today

Closing Statement

At brighthush, we believe that exceptional customer service is the cornerstone of a healthier community. As an Entry‑Level Customer Service Representative – Claims Specialist, you will play a vital role in ensuring that members and providers receive the support they need to navigate the health‑care system with confidence. If you are a motivated, detail‑oriented professional who thrives in a remote, collaborative environment, we invite you to join our team and help us continue to set the standard for claims excellence.

Apply now and start your journey with brighthush – where your work truly matters.