Remote Claims Customer Service Representative – Provider Relations & Claims Resolution Specialist at brighthush

About brighthush

brighthush is a forward‑thinking health‑care solutions provider that empowers seniors and their families to live healthier, more independent lives. Since our founding in 2011, we have grown to a vibrant team of 501‑1,000 professionals dedicated to delivering high‑quality, compliant, and compassionate care coordination services across the United States. Our mission is simple: to bridge the gap between patients, providers, and payers, ensuring that every claim is processed accurately, efficiently, and with the utmost respect for privacy and regulatory standards.

As a fully remote organization, brighthush offers the flexibility and autonomy that modern professionals crave, while still fostering a collaborative, inclusive culture that values innovation, continuous learning, and a shared commitment to excellence. If you thrive in a fast‑paced, technology‑driven environment and want to make a tangible impact on the health‑care experience of millions, brighthush is the place for you.

Why Join brighthush?

• Impactful Work: Every interaction you handle directly influences provider satisfaction, claim accuracy, and ultimately the quality of care for patients.
• Remote Flexibility: Work from anywhere in the USA with a reliable internet connection and a supportive virtual team.
• Growth Opportunities: Accelerate your career with mentorship, cross‑functional projects, and the chance to move into senior support, process improvement, or analytics roles.
• Competitive Compensation & Benefits: We offer a comprehensive package that includes health, dental, vision, life, and disability insurance, a 401(k) plan with company match, paid time off, and more.
• Culture of Excellence: Our values—integrity, collaboration, innovation, and customer focus—guide everything we do.

Key Responsibilities

As a Claims Customer Service Representative at brighthush, you will serve as the primary liaison between our organization and external healthcare providers. Your day‑to‑day tasks will include:

• Responding promptly to provider inquiries regarding medical and dental claims via phone, email, and secure messaging platforms.
• Investigating and resolving claims status issues, denials, payment discrepancies, and other post‑adjudication questions.
• Maintaining up‑to‑date knowledge of benefit plans, claim adjudication guidelines, coding requirements (ICD‑10, CPT, HCPCS), and HIPAA regulations.
• Accurately documenting all interactions, claim actions, and resolutions in our proprietary claims management system, ensuring compliance with internal and external audit standards.
• Communicating complex benefit details in a clear, concise, and empathetic manner to providers, ensuring they understand the rationale behind decisions.
• Collaborating with internal departments—billing, compliance, analytics, and operations—to facilitate seamless resolution of claims‑related issues.
• Identifying recurring pain points and recommending process improvements that enhance service delivery and provider satisfaction.
• Providing a consistently high level of customer service, demonstrating empathy, patience, and professionalism at all times.
• Adhering to all company policies, attendance requirements, and scheduled break times, while maintaining punctuality and reliability.
• Participating in audits, staff meetings, in‑services, and special projects as assigned, contributing to continuous improvement initiatives.
• Remaining flexible to adjust schedules to meet operational demands, including occasional weekend or holiday coverage as needed.

Essential Qualifications

• Minimum of 2 years of experience in a healthcare claims or call‑center environment.
• At least 1 year of experience working remotely, demonstrating self‑discipline and strong time‑management skills.
• High School Diploma or GED; additional education or certifications in health‑care administration, medical billing, or related fields is a plus.
• Proficiency with Microsoft Office Suite (Excel, Outlook, Word) and claims processing software.
• Strong understanding of medical billing terminology, including ICD‑10, CPT, HCPCS, and Explanation of Payments (EOPs).
• Excellent judgment, problem‑solving abilities, and a keen eye for detail.
• Strong oral and written communication skills, with the ability to convey complex information clearly and concisely.
• Ability to manage multiple priorities in a fast‑paced environment while maintaining accuracy and compliance.
• Empathetic, customer‑focused mindset with a collaborative approach to teamwork.
• Knowledge of HIPAA regulations and a commitment to maintaining patient confidentiality.

Preferred Qualifications

• Certification in medical billing or coding (e.g., Certified Professional Coder, Certified Billing and Coding Specialist).
• Experience with claims management platforms such as Epic, Cerner, or Athenahealth.
• Background in health‑care compliance or audit support.
• Fluency in additional languages (Spanish, Mandarin, etc.) to serve a diverse provider base.
• Experience leading process improvement initiatives or participating in Six Sigma projects.

Skills & Competencies

• Customer‑Centric Service: Deliver exceptional service that builds trust and long‑term relationships with providers.
• Analytical Thinking: Quickly assess claim data, identify root causes, and propose effective solutions.
• Technical Proficiency: Comfortable navigating multiple software platforms and troubleshooting basic technical issues.
• Communication: Articulate complex information in a manner that is easily understood by non‑technical stakeholders.
• Adaptability: Thrive in a dynamic environment with evolving policies, technology, and provider needs.
• Team Collaboration: Work effectively with cross‑functional teams, sharing insights and best practices.
• Continuous Learning: Stay current on industry trends, regulatory changes, and emerging best practices.

Career Growth & Learning Opportunities

At brighthush, we believe in investing in our people. As a Claims Customer Service Representative, you will have access to:

• Structured onboarding and mentorship programs that accelerate your learning curve.
• Regular training sessions on new coding updates, compliance changes, and technology upgrades.
• Cross‑training opportunities in billing, analytics, or compliance to broaden your skill set.
• Clear career pathways to senior support roles, process improvement leads, or analytics specialists.
• Annual performance reviews with actionable feedback and personalized development plans.

Work Environment & Culture

brighthush’s remote-first culture is built on trust, transparency, and collaboration. Our virtual team enjoys:

• Weekly virtual coffee chats and monthly town‑hall meetings to keep everyone connected.
• Access to a digital collaboration hub (Slack, Teams, or similar) for real‑time communication.
• Flexible work hours that accommodate different time zones and personal commitments.
• A supportive HR team that champions work‑life balance and employee well‑being.
• Regular virtual team‑building activities, such as trivia nights, wellness challenges, and skill‑sharing workshops.

Compensation & Benefits

While the exact salary will be determined based on experience and qualifications, we offer a competitive compensation package that includes:

• Base salary commensurate with industry standards for remote claims support roles.
• 401(k) plan with company match to help you build long‑term wealth.
• Health, dental, and vision insurance plans with comprehensive coverage options.
• Health Savings Account (HSA) and Flexible Spending Account (FSA) to manage out‑of‑pocket medical expenses.
• Life and disability insurance to protect you and your loved ones.
• Paid sick leave, paid time off (PTO), and a generous holiday schedule.
• Employee Assistance Program (EAP) for mental health support and counseling services.
• Employee discount program for health‑related products and services.
• Referral bonus program for bringing talented peers into the brighthush family.
• Continuous professional development stipend to support certifications, courses, or conferences.

How to Apply

Ready to make a difference in the lives of providers and patients alike? Click the link below to submit your application and join the brighthush team. We look forward to learning how your skills and passion align with our mission.