Remote Customer Service Representative – Benefits & Claims Support Specialist at brighthush

About brighthush

brighthush is a leading provider of integrated healthcare management solutions, dedicated to helping self‑funded employers control costs, mitigate risk, and deliver exceptional member experiences. With a legacy that dates back to 1913, brighthush has evolved into a modern, technology‑driven organization that places people at the heart of everything we do. Our mission is to empower organizations to provide high‑quality, affordable care while fostering a culture of innovation, collaboration, and continuous improvement.

Why Join brighthush?

As a remote‑first company, brighthush offers the flexibility to work from anywhere in the United States while still being part of a vibrant, global team. We invest heavily in employee development, provide competitive compensation, and celebrate achievements through performance‑based incentives. If you thrive in a fast‑paced, high‑volume environment and want to make a real impact on the lives of employees, members, and providers, brighthush is the place for you.

Key Responsibilities

• Deliver exceptional, accurate, and courteous service to employees, members, providers, and clients via phone, email, and chat, addressing inquiries related to benefits, eligibility, claims, and plan documents.
• Handle a high volume of inbound and outbound calls while maintaining a calm, professional demeanor and adhering to established quality standards.
• Navigate multiple system applications and screens simultaneously, leveraging proprietary tools to retrieve information, update records, and resolve issues in real time.
• Document every interaction meticulously in the customer relationship management (CRM) system, ensuring all actions taken are recorded in compliance with brighthush policies and regulatory requirements.
• Escalate complex or unresolved issues to the appropriate specialist teams, following the defined escalation matrix and maintaining clear communication throughout the process.
• Participate in continuous improvement initiatives, providing feedback on process gaps, system enhancements, and training needs.
• Adhere to performance metrics such as average handle time, first‑contact resolution, and customer satisfaction scores, consistently meeting or exceeding targets.
• Stay current on product knowledge, including medical procedure and diagnosis coding, medical terminology, and Summary Plan Documents (SPDs), to provide accurate guidance.
• Support self‑funded insurance, benefits, and third‑party administrator (TPA) operations, ensuring compliance with industry standards and client expectations.

Essential Qualifications

• High school diploma or GED equivalent.
• Minimum of one year of customer service experience, preferably in a call center or healthcare support environment.
• Strong verbal, written, and interpersonal communication skills, with the ability to explain complex concepts in a clear, concise manner.
• Proven ability to work efficiently in a fast‑paced, high‑volume setting while maintaining accuracy and attention to detail.
• Excellent problem‑solving skills, with a track record of resolving customer issues quickly and effectively.
• Proficiency in navigating multiple software applications and screens simultaneously, with a strong aptitude for learning new systems.
• Basic proficiency in Microsoft Excel and Word, and comfort using web‑based tools and databases.
• Self‑motivated, flexible, and open to continuous process improvement and learning.

Preferred Qualifications

• Experience in a high‑volume call center environment, particularly within the healthcare or insurance sectors.
• Prior exposure to self‑funded insurance, benefits administration, or TPA operations.
• Knowledge of medical procedure and diagnosis coding (ICD‑10, CPT, HCPCS).
• Familiarity with medical terminology and the structure of Summary Plan Documents (SPDs) or insurance booklets.
• Experience working in a performance‑measured environment with quality metrics and incentive programs.
• Understanding of compliance regulations such as HIPAA, ACA, and ERISA.

Skills & Competencies

• Customer‑Centric Mindset: Passion for helping others and a genuine desire to solve problems.
• Technical Proficiency: Comfortable with multiple concurrent applications, data entry, and troubleshooting basic technical issues.
• Analytical Thinking: Ability to assess situations, identify root causes, and recommend effective solutions.
• Time Management: Prioritize tasks, manage call queues, and meet productivity targets without sacrificing quality.
• Adaptability: Thrive in a dynamic environment, quickly adjusting to new processes, tools, and policies.
• Collaboration: Work effectively with cross‑functional teams, including claims, enrollment, and technical support.
• Resilience: Maintain composure under pressure, handle difficult customers, and recover from setbacks.

Career Growth & Learning Opportunities

At brighthush, we believe in nurturing talent and providing clear pathways for advancement. As a Customer Service Representative, you will have the opportunity to:

• Progress to senior support roles, such as Team Lead or Quality Analyst, by demonstrating leadership and expertise.
• Transition into specialized areas like Claims Processing, Enrollment Management, or Technical Support.
• Participate in our comprehensive learning and development program, which includes online courses, certifications, and mentorship.
• Attend quarterly knowledge‑sharing sessions with subject‑matter experts across the organization.
• Leverage our internal mobility platform to explore roles in other departments, such as Product Management, Sales, or Operations.

Work Environment & Culture at brighthush

brighthush fosters a culture of transparency, collaboration, and innovation. Our remote workforce enjoys:

• Flexible scheduling that respects work‑life balance.
• Regular virtual team‑building events, hackathons, and wellness challenges.
• A supportive manager who provides real‑time feedback and coaching.
• Access to cutting‑edge technology, including AI‑powered chatbots and analytics dashboards.
• A commitment to diversity, equity, and inclusion, with employee resource groups and inclusive hiring practices.

Compensation & Benefits

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

• Competitive base salary with performance‑based annual bonuses.
• Health, dental, and vision insurance plans, with options for self‑funded coverage.
• 401(k) retirement plan with company match.
• Paid time off, including vacation, sick leave, and paid holidays.
• Paid parental leave for new parents.
• Disability and supplemental life insurance.
• Employee Assistance Program (EAP) for mental health and well‑being support.
• Tuition reimbursement for approved courses and certifications.
• Annual training program (4–6 weeks) to equip you with the skills needed for success.
• Annual bonus incentive tied to individual and team performance metrics.

How to Apply

Ready to join a forward‑thinking organization that values your expertise and offers a platform for growth? Click the link below to submit your application and take the first step toward an exciting career at brighthush.