Remote Health Plans Customer Service Advocate – Claims, Benefits & Eligibility Specialist at brighthush

About brighthush

brighthush is a leading health‑care organization dedicated to delivering high‑quality, patient‑centered services across the United States. With a legacy that dates back to 1965, brighthush has grown into a vibrant community of over 10,000 professionals who work together to provide urgent care, virtual appointments, and in‑person visits that meet the evolving needs of our members. Our mission is simple yet powerful: to improve health outcomes through compassionate care, innovative technology, and a relentless focus on member satisfaction.

As a remote‑first employer, brighthush empowers its teams to work from anywhere in the U.S., fostering a flexible, collaborative culture that values work‑life balance, continuous learning, and personal growth. If you’re passionate about helping people navigate the complexities of health insurance and thrive in a fast‑paced, customer‑centric environment, brighthush is the place for you.

Position Overview

We are seeking a dedicated Health Plans Customer Service Advocate to join our remote call‑center team. In this role, you will be the frontline champion for our members, providers, and partner organizations, ensuring that every interaction is handled with accuracy, empathy, and a commitment to one‑call resolution. You will play a critical role in interpreting claims, benefits, eligibility, and network status, turning complex inquiries into clear, actionable solutions.

Key Responsibilities

• Act as a brand ambassador for brighthush, consistently promoting our mission, vision, values, and strategic goals in every customer interaction.
• Maintain a positive, collaborative team environment by sharing best practices, offering peer support, and actively participating in team meetings and training sessions.
• Meet and exceed customer service performance metrics, including call handling time, first‑contact resolution, and member satisfaction scores.
• Explain the adjudication process for claims, detailing how deductibles, co‑pays, co‑insurance, and provider reimbursements are calculated and applied.
• Provide timely, accurate assistance to members, providers, billing departments, and other insurance carriers regarding claims status, benefits eligibility, and network participation.
• Document all interactions in the customer relationship management (CRM) system, ensuring data integrity and compliance with regulatory standards.
• Investigate and resolve issues arising from claim adjudication, billing discrepancies, or service inquiries, escalating to higher‑level support when necessary.
• Monitor and respond to customer service inquiries via email, ensuring a consistent, high‑quality experience across all communication channels.
• Collaborate with cross‑functional teams—such as Claims, Billing, Provider Relations, and IT—to streamline processes and improve member experience.
• Participate in continuous improvement initiatives, providing feedback on system enhancements, workflow optimizations, and policy updates.

Essential Qualifications

• Minimum of one year of experience in a customer‑service role, preferably within health insurance, healthcare, or a related industry.
• Strong understanding of health insurance concepts, including claims processing, benefits administration, eligibility verification, and provider network management.
• Proficiency in navigating multiple software platforms simultaneously—CRM, claims adjudication systems, and Microsoft Office suite—while maintaining high typing accuracy.
• Excellent verbal and written communication skills, with the ability to explain complex information in a clear, concise manner.
• Demonstrated problem‑solving abilities, including analytical thinking and a methodical approach to troubleshooting.
• Exceptional organizational skills, with a proven track record of managing multiple tasks, prioritizing effectively, and meeting deadlines.
• Self‑motivated, independent worker who thrives in a remote setting, while also being a collaborative team player.
• High level of professionalism, integrity, and a genuine commitment to delivering outstanding member service.

Preferred Qualifications

• Experience working with claims adjudication software such as SAP, Epic, or Cerner.
• Knowledge of HIPAA regulations and data privacy best practices.
• Previous exposure to provider network management or billing processes.
• Multilingual abilities, especially in Spanish, French, or other widely spoken languages in the U.S.
• Certification in Customer Service Excellence or a related field.

Skills & Competencies

• Customer‑centric mindset with a passion for resolving member issues efficiently.
• Strong analytical and critical‑thinking skills to interpret claims data and policy language.
• Adaptability to changing policies, procedures, and technology platforms.
• Time‑management proficiency, capable of juggling high call volumes while maintaining accuracy.
• Team collaboration, including cross‑departmental communication and knowledge sharing.
• Resilience and emotional intelligence, enabling you to handle challenging conversations with empathy.
• Technical aptitude for troubleshooting software glitches and guiding users through digital tools.

Career Growth & Learning Opportunities

At brighthush, your professional development is a top priority. As a Health Plans Customer Service Advocate, you will have access to:

• Structured onboarding and continuous training programs covering claims, benefits, and industry regulations.
• Mentorship from senior customer‑service leaders and subject‑matter experts.
• Internal career pathways to roles such as Claims Analyst, Provider Relations Specialist, or Customer Experience Manager.
• Regular performance reviews with actionable feedback and personalized development plans.
• Access to a digital learning library featuring courses on healthcare compliance, data analytics, and leadership skills.
• Opportunities to participate in cross‑functional projects that influence company‑wide initiatives.

Work Environment & Culture

brighthush fosters a culture of inclusivity, innovation, and continuous improvement. As a remote employee, you will enjoy:

• Flexible work hours that accommodate your personal life while meeting business needs.
• State‑of‑the‑art virtual collaboration tools—Zoom, Microsoft Teams, and Slack—to stay connected with teammates.
• A supportive manager who values autonomy, provides clear expectations, and offers regular feedback.
• Regular virtual team‑building events, wellness challenges, and recognition programs.
• Access to a digital wellness portal featuring mental‑health resources, fitness challenges, and mindfulness sessions.

Compensation & Benefits

While specific salary ranges are not disclosed in the posting, brighthush offers a competitive compensation package that includes:

• Base salary commensurate with experience and industry standards.
• Performance‑based bonuses and incentive programs.
• Comprehensive health, dental, and vision insurance plans.
• 401(k) retirement plan with company match.
• Paid time off (PTO), holidays, and sick leave.
• Professional development budget and tuition reimbursement.
• Employee assistance program (EAP) and mental‑health support.
• Wellness stipend and access to virtual fitness classes.

Why Join brighthush?

By becoming a Health Plans Customer Service Advocate at brighthush, you will:

• Make a tangible difference in the lives of thousands of members, ensuring they receive the care and support they need.
• Work in a forward‑thinking organization that embraces technology, data, and innovation to improve member experience.
• Benefit from a flexible, remote work model that respects your personal commitments.
• Grow your career through structured learning, mentorship, and clear advancement pathways.
• Join a diverse, inclusive community that values collaboration, empathy, and continuous improvement.

Ready to Apply?

If you are a motivated, customer‑focused professional eager to help members navigate the complexities of health insurance, we invite you to apply today. Join brighthush and become part of a team that is redefining the future of health‑care service.

To submit your application, click the link below and take the first step toward an exciting career with brighthush.