Remote Healthcare Customer Service Specialist – Dental & Medicare Claims Expert – Driving Member Experience, Compliance, and Health Outcomes at brighthush – Join Our Innovative, Data‑Driven, Patient‑Centric Team

About brighthush – Transforming Health Benefit Experiences

At brighthush, we are redefining the way people interact with their health benefits. By blending cutting‑edge data analytics, AI‑powered insights, and a genuine human touch, we empower individuals, providers, and employers to navigate dental and Medicare plans with clarity and confidence. Whether a member is scheduling a routine dental check‑up or a provider is processing a complex Medicare claim, brighthush delivers accuracy, transparency, and care at every touchpoint.

Why brighthush is the Place to Grow Your Career

• Impactful Work – Every call you handle directly improves a member’s experience and helps them make informed health decisions.
• Clear Career Pathways – Structured ladders from Customer Service Specialist to Team Lead, Manager, and cross‑functional roles in Claims, Billing, and Product Development.
• Fully Remote Flexibility – Work from anywhere with a reliable internet connection and a dedicated workspace.
• Competitive Compensation & Benefits – Base pay starts at $16 per hour, with performance bonuses, full medical, dental, and vision coverage from day one, and a robust retirement plan.
• Inclusive Culture – Diversity is at the core of our values. We celebrate new ideas, encourage collaboration, and foster a supportive community where every voice matters.
• Continuous Learning – Access to ongoing training, mentorship, and innovation workshops that keep you ahead of industry trends.
• Work‑Life Harmony – Flexible shift options, paid time off, and a culture that respects personal commitments.

Role Overview: Your Day‑to‑Day Impact

As a Remote Healthcare Customer Service Specialist, you will be the frontline advocate for our members and providers. Your responsibilities span from answering inquiries about dental benefits and Medicare plans to resolving billing disputes and ensuring compliance with industry regulations. You will collaborate closely with cross‑functional teams—claims, billing, product, and compliance—to deliver seamless service and drive continuous improvement.

Key Responsibilities

• Respond to inbound inquiries regarding dental benefits, eligibility, claims, appeals, grievances, and provider searches for both Commercial and Medicare plans.
• Provide clear, consistent explanations of dental benefits, policies, and procedures to members, providers, and employer groups.
• Investigate and resolve member or provider concerns by researching issues, contacting relevant parties, and documenting all interactions accurately within the billing system.
• Escalate billing, claims, or service complaints to appropriate internal departments for follow‑up and resolution.
• Retrieve and send written correspondence, including plan brochures, provider directories, and other printed materials as needed.
• Meet or exceed established Automated Call Distribution (ACD) system call volume and quality performance goals.
• Achieve all assigned individual monthly performance metrics and maintain a high level of accuracy and customer satisfaction.
• Stay current with all Member Services policies, procedures, and dental plan updates.
• Perform additional duties and responsibilities as assigned by management to support team success.
• Participate in regular quality assurance reviews and provide constructive feedback to improve service delivery.
• Collaborate with the Compliance team to ensure all interactions adhere to HIPAA and other regulatory standards.
• Assist in the creation and maintenance of knowledge base articles to empower peers and reduce call volume.

Essential Qualifications

• High school diploma, GED, or college degree.
• At least 1 year of call center experience (preferred).
• 1 year of face‑to‑face customer service experience.
• Knowledge of or prior experience in the Dental, Medical, or Managed Care industry (preferred).
• Strong organizational, time‑management, written and verbal communication, analytical, and problem‑solving skills.
• Proficiency in brighthush, Outlook, and web browsers.
• Effective phone communication skills and the ability to handle multiple variables in standardized situations.
• Self‑motivation, resourcefulness, attention to detail, accountability, and a team‑player mindset.
• Successful completion of a customer service assessment, typing test, and background check.
• Basic understanding of data privacy and confidentiality principles.

Preferred Qualifications

• Experience with dental or Medicare claims processing.
• Familiarity with multiple system navigation (up to 6 systems).
• Previous exposure to a 24/7 call center environment.
• Knowledge of HIPAA regulations and data privacy best practices.
• Experience with CRM or ticketing systems such as brighthush.
• Prior experience in a compliance or audit role within healthcare.

Skills & Competencies

• Customer‑Centric Mindset – Passion for helping others and delivering comprehensive solutions.
• Technical Proficiency – Comfortable learning new software and troubleshooting basic tech issues.
• Communication Excellence – Clear, concise, and empathetic communication across phone, email, and chat.
• Problem‑Solving – Ability to analyze complex issues and propose effective resolutions.
• Adaptability – Thrive in a fast‑paced, evolving environment with shifting priorities.
• Team Collaboration – Work effectively with cross‑functional teams to achieve shared goals.
• Attention to Detail – Ensure accuracy in documentation and compliance adherence.
• Time Management – Balance multiple tasks while maintaining high quality service.

Career Growth & Learning Opportunities

At brighthush, we believe that investing in our people is the key to sustained success. When you join our team, you’ll have access to:

• Structured career ladders that allow you to progress from Customer Service Specialist to Team Lead, Manager, or even cross‑functional roles in Claims, Billing, or Product Development.
• Ongoing training modules covering the latest industry regulations, product updates, and customer service best practices.
• Mentorship programs where seasoned professionals share insights and guidance to accelerate your growth.
• Quarterly performance reviews that provide actionable feedback and help you set clear, measurable goals.
• Opportunities to participate in special projects, process improvement initiatives, and innovation workshops.
• Access to industry conferences, webinars, and certifications that enhance your professional skill set.
• Cross‑departmental shadowing to broaden your understanding of the entire member experience lifecycle.

Training & Onboarding: Your Success Journey Starts Here

We invest in your success from day one. Your training journey includes:

• 5 weeks of classroom instruction covering product knowledge, call handling techniques, and compliance.
• 2 weeks of “nesting” where you shadow experienced agents and gradually take on live calls.
• Mandatory paid training with 100% attendance required.
• Continuous learning modules and quarterly refresher courses.
• Regular check‑ins with your manager and mentor to ensure you’re on track.
• Access to a digital learning portal with micro‑learning videos, quizzes, and knowledge checks.
• Peer‑to‑peer learning circles to share best practices and troubleshoot challenges.

Work Schedule & Hours

Our operations run Monday through Sunday, 7:30 am – 11:00 pm EST. You’ll be scheduled for a 40‑hour week with flexible shift options to accommodate your lifestyle. We offer a variety of shift patterns, including day, evening, and overnight, to ensure you can balance work and personal commitments. Shift scheduling is designed to provide predictable hours and ample time for rest and personal activities.

Compensation & Benefits

• Base Pay – $16.00 per hour (subject to local minimum wage regulations).
• Potential for performance‑based bonuses and incentive programs.
• Full medical, dental, and vision coverage effective on the first day of employment.
• Paid time off accrued after 180 days (approximately 6 months).
• Retirement savings plan with company match.
• Paid holidays and flexible vacation policy.
• Employee assistance program and wellness resources.
• Access to a digital wellness portal with mental health support, fitness challenges, and health coaching.
• Regular team‑building events and virtual happy hours to foster community.
• Comprehensive training stipend for certifications related to healthcare, compliance, or customer service.

Equipment & Workspace Requirements

• brighthush supplies all necessary equipment: computer, monitor, mouse, keyboard, headset, Ethernet cable, and power cables.
• Reliable home internet connection: minimum 10 Mbps download and 3 Mbps upload. Ethernet connection required; satellite or wireless internet is not acceptable.
• Dedicated, distraction‑free workspace that is clutter‑free and secure.
• Comfortable ergonomic chair and desk setup to support long‑duration calls.
• Compliance with data security protocols, including screen privacy filters and secure storage of confidential information.

Application Process

The entire application takes less than 20 minutes and includes:

1. Submit your profile information (2 minutes).
2. Answer pre‑screen questions to confirm eligibility (3 minutes).
3. Complete a typing test (1 minute).
4. Take a short assessment to determine fit and set you up for success (10 minutes).

We encourage you to complete the application promptly to be considered for this role.

Important Notes

• Due to varying state and local minimum wage laws, we can only hire candidates residing in states where our compensation structure complies with applicable wage regulations. We may not consider applicants from certain states or municipalities at this time.
• We are currently NOT hiring in the following geographies: AK, CA, CT, HI, IL, MA, MD, MT, NJ, NY, OR, WA; and metro areas such as Minneapolis‑MN, Washington‑DC, Denver/County of Boulder/Edgewater County‑CO.
• Applicants without a computer may use a public library or other public computer to complete the application.
• All applicants must be able to provide a reliable internet connection and a suitable workspace that meets the technical requirements outlined above.

Be Part of the Future

Ready to make a real difference in people’s health journeys? Apply for this role today and join the brighthush family.