Seasoned Call Center Customer Service Specialist – Healthcare Benefits & Pharmacy Claims Expert – Remote Position for California Residents

About brighthush

brighthush is a pioneering Pharmacy Benefit Manager (PBM) that partners with more than 20 non‑profit health plans and government programs—including Medicare and Medicaid—to deliver seamless, cost‑effective medication coverage for over 33 million members nationwide. Our mission is to simplify the complex world of prescription benefits, ensuring that patients receive the right medication at the right time while keeping costs transparent and manageable. As a forward‑thinking organization, brighthush blends cutting‑edge technology with a people‑first culture, empowering our teams to innovate, collaborate, and grow together.

Why Join brighthush?

At brighthush, you’ll be part of a dynamic, high‑impact team that shapes the future of healthcare benefits. We value curiosity, resilience, and a passion for customer service. Whether you’re a seasoned professional or a recent graduate with a knack for problem‑solving, brighthush offers a platform to:

• Work remotely from the comfort of your home while staying connected to a vibrant, supportive community.
• Engage with real‑world challenges in the pharmacy benefits space, learning about eligibility, claims, authorizations, and care coordination.
• Benefit from structured training, mentorship, and continuous learning opportunities that accelerate your career trajectory.
• Earn a competitive hourly rate, performance bonuses, and a comprehensive benefits package that includes health, dental, vision, and a generous paid time‑off policy.

Key Responsibilities

As a Call Center Customer Service Specialist at brighthush, you will be the first line of contact for members, providers, and internal stakeholders. Your role will involve:

• Customer Interaction: Answer inbound calls regarding eligibility, benefits, claims, and authorization of services, ensuring a courteous and professional experience.
• Data Management: Accurately enter intake documentation into our secure systems, maintaining data integrity and confidentiality.
• Information Retrieval: Research and communicate member eligibility, benefit details, EAP services, claim status, and authorization inquiries.
• Issue Resolution: Resolve administrative concerns, including claim disputes and dissatisfaction, by applying problem‑solving skills and empathy.
• Program Administration: Initiate EAP, Care, and Utilization Management programs by assembling and entering patient information into the appropriate delivery system.
• Provider Education: Guide providers on claim submission processes, treatment plan requirements, and the appeal process.
• Referral Coordination: Make routine referrals and triage decisions, linking patients to the Care Management team, EAP affiliates, or facilities as needed.
• Network Information: Provide accurate reimbursement rates and network details to providers, and refer provider inquiries to the Provider Services team.
• Compliance & Confidentiality: Adhere to all privacy regulations (HIPAA, etc.) and maintain strict confidentiality of member information.

Essential Qualifications

• High school diploma or equivalent (GED) required.
• 3–5 years of customer service experience in a high‑volume environment, preferably within healthcare or pharmaceutical settings.
• Typing speed of 40+ words per minute with strong written and verbal communication skills.
• Proficiency in navigating multiple computer platforms simultaneously while on a call.
• Flexibility to work across various shifts, including weekends, with a willingness to adapt to changing schedules.
• Strong problem‑solving abilities and a calm, patient demeanor when handling complex inquiries.
• Reliable home‑office setup: high‑speed Ethernet connection (≥150 Mbps), quiet environment, and a functioning video camera for training and meetings.
• California residency is mandatory.

Preferred Qualifications

• Experience with PBM or health insurance claim processing.
• Familiarity with EAP (Employee Assistance Program) and care coordination workflows.
• Knowledge of Medicare, Medicaid, and other government benefit programs.
• Previous remote work experience with a proven track record of meeting performance metrics.
• Certifications in customer service, healthcare administration, or related fields.

Skills & Competencies

• Communication: Clear, concise, and empathetic verbal and written communication.
• Technical Proficiency: Comfortable using CRM systems, data entry tools, and virtual collaboration platforms.
• Time Management: Ability to prioritize tasks, manage call volume, and meet performance targets.
• Adaptability: Thrive in a fast‑changing environment, embracing new processes and technologies.
• Team Collaboration: Work effectively with cross‑functional teams, including Provider Services, Care Management, and IT.
• Customer‑Centric Mindset: Focus on delivering exceptional service and building trust with members and providers.

Career Growth & Learning Opportunities

brighthush is committed to your professional development. As a Call Center Customer Service Specialist, you will have access to:

• Structured onboarding and a 5‑week training program covering eligibility, claims, authorizations, and system navigation.
• Mentorship from experienced team leads and subject‑matter experts.
• Cross‑training in related areas such as claims adjudication, provider relations, and care management.
• Opportunities to transition into higher‑level roles such as Claims Analyst, Customer Experience Manager, or Program Coordinator.
• Regular performance reviews and goal‑setting sessions to align your growth trajectory with brighthush’s strategic objectives.

Work Environment & Company Culture

brighthush fosters a culture of inclusion, innovation, and continuous improvement. Key highlights include:

• Fully remote work model with flexible scheduling to accommodate California residents’ lifestyles.
• Collaborative virtual environment using video conferencing, instant messaging, and shared knowledge bases.
• Regular virtual team‑building events, wellness challenges, and recognition programs.
• A commitment to diversity, equity, and inclusion, ensuring every voice is heard and valued.
• Transparent communication from leadership, with quarterly town‑halls and open‑door policy for feedback.

Compensation & Benefits

While specific figures may vary based on experience, brighthush offers:

• Competitive hourly wage with performance‑based incentives.
• Health, dental, and vision insurance options.
• 401(k) retirement plan with company match.
• Paid time off (PTO) and paid holidays.
• Professional development stipend and access to online learning platforms.
• Equipment stipend: laptop, headset, high‑speed Ethernet cable, and a 2‑meter LAN cable for reliable connectivity.
• Comprehensive onboarding package, including a dedicated workspace setup guide.

Training & Onboarding

Our 5‑week training program is designed to equip you with the knowledge and skills needed to excel:

• Weeks 1–3: Full‑day sessions (8:00 am – 5:00 pm) covering eligibility, benefits, claims, and system navigation.
• Weeks 4–5: Focused modules (8:00 am – 4:30 pm) on advanced claim resolution, EAP processes, and provider relations.
• Training is conducted via live video sessions; a video camera is required for all training and team meetings.
• No time‑off is allowed during training; attendance and participation are critical for success.
• After training, you will receive ongoing coaching and performance feedback.

Shift Flexibility & Availability

brighthush operates 24/7, and we require representatives to be flexible across the following schedule options:

• Shift hours: 8 hours between 6 am – 10 pm Pacific Time.
• No graveyard shift; however, you must be available for either both weekend days or one weekend day.
• Shift assignments will be distributed across the week, and you may work any 5 days, including a weekend day.
• California residency is mandatory for all positions.

How to Apply

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