Seasoned Claims Customer Service Representative – Healthcare Claims Processing & Provider Relations Specialist at brighthush

About brighthush

brighthush is a leading provider of integrated health solutions dedicated to empowering seniors to live independently and with dignity in the comfort of their own homes. Leveraging a participant‑centered, interdisciplinary approach, we design personalized care plans that combine high‑quality medical services with robust community support. Our mission is to enhance the quality of life for our participants, fostering independence, safety, and well‑being through innovative, community‑based healthcare delivery.

Why Join brighthush

At brighthush, you’ll be part of a dynamic team that values compassion, collaboration, and continuous improvement. We believe that every team member plays a vital role in shaping the future of senior care. By joining us, you’ll:

• Contribute to meaningful outcomes that directly impact seniors’ lives.
• Work in a culture that prioritizes employee growth, well‑being, and professional development.
• Benefit from competitive compensation, comprehensive benefits, and a flexible work environment.
• Collaborate with experts across healthcare, technology, and community services.

Role Overview

The Claims Customer Service Representative (CCSR) is a pivotal liaison between brighthush and external healthcare providers. This role handles incoming inquiries related to medical and dental claims, ensuring accurate, timely, and compliant resolution of provider questions and claim issues. The CCSR must demonstrate exceptional professionalism, confidentiality, and efficiency while managing multiple priorities in a fast‑paced environment.

Key Responsibilities

Provider Interaction & Support

• Respond promptly to provider inquiries via phone, email, and secure messaging platforms.
• Explain complex benefit details, claim adjudication processes, and payment information in a clear, concise manner.
• Maintain a high level of empathy and professionalism when addressing provider concerns.

Claims Issue Resolution

• Investigate and resolve claim status discrepancies, denials, and payment errors.
• Collaborate with internal departments (Billing, Coding, Compliance) to expedite claim resolution.
• Document all interactions and claim actions accurately in the brighthush system, adhering to compliance standards.

Process Improvement & Quality Assurance

• Identify recurring claim issues and recommend process enhancements to improve service delivery.
• Participate in audits, staff meetings, and continuous improvement projects.
• Ensure adherence to HIPAA regulations, privacy policies, and internal quality metrics.

Administrative & Operational Duties

• Maintain accurate records of provider interactions and claim resolutions.
• Adhere to attendance policies, punctuality, and break schedules.
• Adjust work schedule as needed to meet operational demands.
• Perform other related duties as assigned to support team objectives.

Essential Qualifications

• High School Diploma or GED (minimum).
• Minimum of 2 years of professional work experience.
• Proficiency in Microsoft Office Suite (Excel, Outlook, Word).
• Strong oral and written communication skills.
• Excellent organizational skills with the ability to multitask and maintain attention to detail under pressure.
• Knowledge of medical billing terminology (ICD‑10, CPT, HCPCS) and Explanation of Payments (EOPs).
• Demonstrated ability to learn and apply regulatory requirements quickly.
• Strong interpersonal and problem‑solving skills with a collaborative mindset.
• Commitment to maintaining confidentiality and compliance with HIPAA.

Preferred Qualifications

• At least 1 year of experience working in a healthcare call center.
• Experience with claims processing software and electronic health record (EHR) systems.
• Remote work experience and self‑management skills.
• Familiarity with brighthush’s benefit plans and claim adjudication guidelines.
• Previous exposure to provider relations and claims dispute resolution.

Skills & Competencies

• Customer‑centric mindset with a passion for service excellence.
• Analytical thinking and data‑driven decision making.
• Adaptability to evolving processes, technologies, and regulatory changes.
• Team collaboration and cross‑functional communication.
• Proactive problem‑solving and continuous improvement orientation.
• Strong time‑management and prioritization abilities.

Career Growth & Development

At brighthush, we invest in your professional journey. The Claims Customer Service Representative role serves as a launchpad for advancement into:

• Senior Claims Analyst or Claims Manager positions.
• Provider Relations Specialist or Account Management roles.
• Quality Assurance or Compliance Officer tracks.
• Leadership development programs and mentorship opportunities.

We offer ongoing training, certification support, and access to industry conferences to keep you at the forefront of healthcare claims processing.

Work Environment & Culture

brighthush fosters a culture of CARE, COMPASSION, CULTURE, COMMUNITY, and COMMITMENT. Our workplace is:

• Inclusive and diverse, welcoming individuals from all backgrounds.
• Collaborative, encouraging open dialogue and shared learning.
• Supportive, with a focus on employee well‑being and work‑life balance.
• Innovation‑driven, empowering teams to experiment and improve processes.

Compensation & Benefits

While specific salary ranges may vary, brighthush offers a competitive compensation package that includes:

• Base salary commensurate with experience and market standards.
• Performance‑based bonuses and incentive programs.
• Comprehensive health, dental, and vision insurance plans.
• 401(k) retirement plan with company match.
• Flexible spending accounts (FSA) and health savings accounts (HSA).
• Paid sick leave, vacation, and personal days.
• Employee assistance program and wellness resources.
• Employee discount program and referral bonuses.
• Professional development stipend and tuition reimbursement.

How to Apply

Ready to make a difference in seniors’ lives while advancing your career? Submit your application through our online portal or click the link below to view the full job posting and apply directly.

Apply to this position at brighthush

Closing

At brighthush, we believe that compassionate care begins with a dedicated team. If you are a detail‑oriented, customer‑focused professional who thrives in a collaborative, fast‑paced environment, we invite you to join us as a Claims Customer Service Representative. Together, we’ll transform the way seniors experience healthcare, ensuring they receive the support and dignity they deserve.