Experienced Medicare Customer Service Representative – Member Support & Health Plan Engagement Specialist

About brighthush

brighthush is a leading third‑party service provider that partners with Medicare health plans to deliver seamless enrollment, activation, and ongoing member support. With a mission to connect beneficiaries to the care they need, brighthush leverages innovative technology and a people‑first culture to drive better health outcomes and higher member satisfaction. Since our founding, we have grown into a trusted partner for national and regional payers, helping them navigate the complexities of Medicare while ensuring every member feels heard, cared for, and empowered.

Position Overview

As a Medicare Customer Service Representative at brighthush, you will be the first point of contact for members navigating their Medicare benefits. Your role will blend compassionate communication with data‑driven problem solving, ensuring that each member receives timely, accurate information and support. You will work in a dynamic call‑center environment, handling inbound and outbound calls, coordinating appointments, and facilitating access to community resources. Your dedication to first‑call resolution and member advocacy will directly influence member retention, satisfaction, and overall program success.

Key Responsibilities

• Member Outreach & Support: Field inbound calls and conduct outbound outreach to newly enrolled members, ensuring they understand their benefits and available resources.
• First‑Call Resolution: Resolve member inquiries on the first interaction whenever possible, escalating only when necessary and documenting all actions in the CRM.
• Appointment Coordination: Schedule initial health screenings, primary care visits, and specialty appointments, providing status updates on prior authorizations and claim questions.
• Benefit Education: Explain benefits, coverage details, and claim processes, including ID card replacement and explanation of benefits statements.
• Social Determinants of Health: Conduct assessments of social determinants, identify gaps, and provide release assessments to connect members with community services.
• Quality & Compliance: Adhere to brighthush’s compliance policies, maintain confidentiality, and support quality metrics such as call handling, first‑call resolution, and member retention.
• Technology Utilization: Use dual monitors and computer‑based resources to retrieve information, navigate multiple systems, and document interactions accurately.
• Performance Metrics: Meet or exceed productivity targets, call monitoring scores, and other key performance indicators set by the call‑center operations team.
• Continuous Learning: Complete required training modules, stay current on Medicare policy changes, and apply new knowledge to improve member service.
• Flexibility: Work evenings and weekends as needed to accommodate member schedules and operational demands.

Essential Qualifications

• High school diploma or GED.
• Minimum of 6 months of Medicare healthcare customer service experience.
• Excellent verbal and written communication skills in English.
• Proficient computer skills and ability to navigate multiple systems simultaneously.
• Strong active listening, empathy, and problem‑solving abilities.
• Ability to handle high‑volume inbound and outbound calls while maintaining composure.
• Self‑motivated with a performance‑driven mindset.
• Positive, can‑do attitude and a collaborative team spirit.

Preferred Qualifications

• Fluency in Spanish (written and spoken) is highly preferred.
• Experience with Medicare Advantage or Medicare Supplement plans.
• Knowledge of social determinants of health frameworks.
• Prior experience in a call‑center environment with dual‑monitor setup.
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