Seasoned Remote FEP Customer Service Representative – Health Insurance Claims Specialist (Full‑Time) – Drive Member Success at brighthush

About brighthush

brighthush stands at the forefront of the health‑insurance industry, serving a diverse membership base of over 12 million individuals across the United States. With a relentless focus on innovation, community partnership, and exceptional care, brighthush has become a trusted name for members seeking clarity, compassion, and reliable support. Our mission is simple yet powerful: to empower people to live healthier lives by providing clear, compassionate, and reliable support whenever they need it. Whether you’re a seasoned professional or just beginning your career, brighthush offers a culture of collaboration, continuous learning, and a shared vision that turns everyday work into meaningful impact.

Why This Role Is a Game‑Changer

As a frontline advocate, you’ll be the first point of contact for members navigating their benefits. Your voice, empathy, and analytical mindset will shape the experience of thousands of individuals seeking clarity and resolution. Working remotely from your home office, you’ll enjoy the flexibility of a home‑based schedule while staying connected to a vibrant, mission‑driven team that values every contribution. This role is not just about answering calls; it’s about building trust, simplifying complex processes, and ensuring that every member feels heard and supported.

Key Responsibilities

• Member Support & Claims Processing: Resolve member inquiries regarding coverage, benefits, and claims with empathy, accuracy, and a sense of urgency. Each interaction is an opportunity to reinforce brighthush’s commitment to exceptional service.
• Policy Interpretation: Apply brighthush policies and regulatory guidelines to answer questions and guide members through complex processes. Translate policy language into clear, actionable information that empowers members to make informed decisions.
• Documentation & Data Entry: Record all interactions in our systems with meticulous attention to detail, ensuring data integrity and compliance. Accurate documentation is essential for audit readiness and continuous improvement.
• System Navigation: Master Microsoft Office Suite, Facets, Inquiry Control System, Interactive Voice Response (IVR), and Automated Call Distribution (ACD) to manage calls and data efficiently. Your technical fluency will enable you to troubleshoot issues and provide seamless support.
• Continuous Improvement: Identify trends, provide actionable feedback, and collaborate with cross‑functional teams to enhance member experience and operational excellence. Your insights help shape future policies and processes.
• Quality Assurance: Participate in call monitoring and quality reviews, ensuring that every member interaction meets brighthush’s high standards for accuracy, empathy, and compliance.
• Team Collaboration: Work closely with supervisors, claims specialists, and other departments to resolve complex member needs and contribute to a culture of shared success.

Essential Qualifications

• Education: High school diploma or GED (college coursework or a degree is a plus). A background in health‑care, business, or a related field is advantageous.
• Experience: Minimum of 1 year of customer service experience, preferably in health‑insurance or a related field. Experience handling high‑volume call traffic is a strong asset.
• Communication Skills: Strong verbal and written communication skills in English, with the ability to convey complex information in a clear, concise, and empathetic manner.
• Technical Proficiency: Proficiency with Microsoft Office (Word, Excel, Outlook) and experience using call‑center software. Familiarity with database entry and data validation is essential.
• Policy Interpretation: Ability to interpret complex policies and translate them into clear, actionable information for members. A keen eye for detail and a methodical approach to problem‑solving are required.
• Organizational Skills: Excellent organizational skills and attention to detail in a sedentary, key‑heavy environment. Ability to manage multiple tasks while maintaining high quality.
• Self‑Motivation: Self‑motivated, proactive, and comfortable working independently in a remote setting. Strong time‑management skills and a disciplined work ethic are essential.

Preferred Qualifications

• Experience with Facets or similar health‑insurance claims platforms, including data entry, claim status updates, and member communication.
• Knowledge of health‑insurance terminology, benefits, and regulatory requirements such as HIPAA, ACA, and state‑specific mandates.
• Prior exposure to IVR and ACD systems, with a proven track record of navigating call‑center technology efficiently.
• Demonstrated ability to handle high‑volume call traffic while maintaining quality service and meeting performance metrics.
• Background in data analysis or reporting, including the ability to extract insights from call logs and member feedback.
• Experience in a remote or hybrid environment, with a reliable home‑office setup and strong digital collaboration skills.

Core Skills & Competencies

• Customer‑Centric Mindset: Passion for helping people and a genuine desire to improve member outcomes. You thrive on making a difference in someone’s day.
• Problem‑Solving: Ability to analyze issues, identify root causes, and propose effective solutions. You approach challenges with a logical, data‑driven mindset.
• Technical Proficiency: Comfortable navigating multiple software platforms and troubleshooting basic technical issues. You’re quick to learn new tools and adapt to evolving technology.
• Time Management: Efficiently manage call queues, documentation, and follow‑ups within tight deadlines. You prioritize tasks without compromising quality.
• Collaboration: Work seamlessly with team members, supervisors, and other departments to resolve complex member needs. You value open communication and teamwork.
• Adaptability: Thrive in a dynamic environment with evolving policies and technology updates. You remain calm and focused amid change.
• Attention to Detail: Maintain high accuracy in data entry, documentation, and policy interpretation. Small errors can have big impacts, so precision is key.
• Resilience: Handle challenging member interactions with composure and professionalism, turning difficult situations into positive outcomes.

Career Growth & Learning Opportunities

At brighthush, we believe in investing in our people. As an FEP Customer Service Representative, you’ll have access to:

• Structured onboarding and mentorship programs that accelerate your learning curve and help you hit the ground running.
• Regular training sessions on new policies, technology upgrades, and customer‑service best practices, ensuring you stay ahead of industry trends.
• Clear career pathways to roles such as Senior Claims Specialist, Team Lead, or Operations Manager, with transparent promotion criteria and performance reviews.
• Cross‑functional projects that expose you to different aspects of the health‑insurance ecosystem, broadening your skill set and professional network.
• Access to an internal learning portal featuring courses, certifications, and industry webinars, allowing you to pursue continuous professional development on your own schedule.
• Opportunities to lead initiatives, such as process improvement projects or member education campaigns, giving you hands‑on leadership experience.

Work Environment & Company Culture

brighthush fosters a culture of inclusivity, transparency, and continuous improvement. Even though this role is remote, you’ll feel part of a tight‑knit community through:

• Weekly virtual team huddles and monthly all‑hands meetings that keep everyone aligned and informed.
• Digital collaboration tools (Slack, Teams, SharePoint) that keep communication fluid and documentation accessible.
• Annual virtual retreats and quarterly town‑hall sessions where leadership shares vision, strategy, and celebrates milestones.
• Employee resource groups that celebrate diversity and provide support networks for underrepresented communities.
• Recognition programs that celebrate milestones, achievements, and innovative ideas, ensuring that hard work is acknowledged and rewarded.
• Flexible work hours and a results‑oriented approach that respects your work‑life balance while delivering on our mission.

Compensation & Benefits

brighthush offers a competitive compensation package designed to reward performance and dedication:

• Salary Range: $16,000 – $31,000 per year, commensurate with experience and performance. We also offer performance bonuses and incentive programs to recognize outstanding contributions.
• Paid Time Off: Generous vacation, sick leave, and personal days to maintain work‑life balance. We also provide paid holidays and a flexible leave policy for personal or family needs.
• Retirement Plan: 401(k) with company match to secure your financial future. We provide financial planning resources and retirement education.
• Health & Wellness: Comprehensive medical, dental, and vision plans, plus wellness stipends for gym memberships, mental‑health resources, and health‑coaching sessions.
• Professional Development: Tuition reimbursement for relevant courses and certifications, as well as access to industry conferences and workshops.
• Employee Assistance Program: Confidential counseling and support services for you and your family.
• Additional perks such as flexible work hours, remote‑work stipends, and employee discounts on health‑related products and services.

How to Apply

Ready to make a tangible impact on the lives of our members? Submit your application through our careers portal and join a team that values integrity, innovation, and service excellence. We look forward to welcoming you to brighthush!