Seasoned Senior Claims Customer Service Representative – Healthcare Claims Processing, Provider Relations, and Senior Care Solutions Specialist – Join brighthush

Welcome to brighthush – Where Compassion Meets Innovation

At brighthush, we are redefining senior care by blending a participant‑centered philosophy with cutting‑edge technology. Our mission is simple yet profound: to empower seniors to live independently, safely, and with dignity in the comfort of their own homes. We design personalized care plans that integrate high‑quality medical services, preventive wellness, and robust community support, ensuring that every participant receives the best possible care.

In an era where the aging population is growing rapidly, the demand for reliable, transparent, and efficient healthcare claims processing has never been higher. brighthush stands at the forefront of this transformation, combining data‑driven insights with a human‑first approach to deliver outcomes that matter. As a leader in senior care solutions, we are committed to continuous innovation, regulatory excellence, and a culture that values every team member’s contribution.

Why You’ll Love Working at brighthush

When you join brighthush, you become part of a dynamic, mission‑driven team that values compassion, collaboration, and continuous improvement. Here’s what makes brighthush a truly exceptional place to work:

• Make a tangible impact: Your daily work directly influences the health and happiness of seniors across the region.
• Grow professionally: We invest in your development through mentorship, training, and certification support.
• Enjoy a supportive culture: Our environment prioritizes employee well‑being, work‑life balance, and inclusive collaboration.
• Benefit from competitive rewards: Competitive compensation, comprehensive benefits, and flexible work arrangements.
• Collaborate with experts: Work alongside healthcare professionals, technology innovators, and community service leaders.

About the Senior Claims Customer Service Representative Role

The Senior Claims Customer Service Representative (CCSR) serves as the pivotal liaison between brighthush and external healthcare providers. In this role, you will handle incoming inquiries related to medical and dental claims, ensuring accurate, timely, and compliant resolution of provider questions and claim issues. Your professionalism, confidentiality, and efficiency will be critical in managing multiple priorities in a fast‑paced environment.

As a senior member of the team, you will also mentor junior representatives, contribute to process improvement initiatives, and act as a subject‑matter expert on complex claim scenarios. Your deep understanding of healthcare billing, provider relations, and regulatory compliance will help shape the future of our claims operations.

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.
• Build and sustain strong relationships with providers, fostering trust and collaboration.
• Document all interactions and claim actions accurately in the brighthush system, adhering to compliance standards.
• Proactively identify opportunities to streamline communication and reduce response times.

Claims Issue Resolution

• Investigate and resolve claim status discrepancies, denials, and payment errors.
• Collaborate with internal departments (Billing, Coding, Compliance) to expedite claim resolution.
• Escalate complex issues to senior analysts or managers when necessary, ensuring timely follow‑up.
• Track and report on claim resolution metrics to identify trends and opportunities for improvement.
• Develop root‑cause analyses for recurring issues and present findings to leadership.

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.
• Track key performance indicators (KPIs) and provide actionable insights to leadership.
• Champion a culture of quality and compliance across the claims team.
• Lead pilot projects for new claim management tools and workflows.

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.
• Assist in onboarding new team members and updating training materials.

Essential Qualifications

• High School Diploma or GED (minimum).
• Minimum of 2 years of professional work experience in a customer‑service or claims‑processing environment.
• 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.
• Experience using claims management software and electronic health record (EHR) systems.

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.
• Certification in medical billing or coding (e.g., Certified Professional Coder).

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.
• Ability to handle sensitive information with discretion and integrity.

Career Growth & Development

At brighthush, we invest in your professional journey. The Senior 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. Whether you aspire to lead a team, specialize in a niche area, or transition into a strategic role, brighthush provides the resources and guidance to help you succeed.

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 and experiences.
• Collaborative: encouraging open dialogue, shared learning, and cross‑departmental teamwork.
• Supportive: with a focus on employee well‑being, mental health, and work‑life balance.
• Innovation‑driven: empowering teams to experiment, iterate, and improve processes.
• Results‑oriented: celebrating achievements while maintaining a compassionate approach to care.

Our remote‑first model means you can work from anywhere while staying connected through daily stand‑ups, virtual coffee breaks, and collaborative project tools. We also host quarterly in‑person retreats to strengthen team bonds and share best practices.

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.
• Remote work flexibility and ergonomic home‑office support.
• Annual wellness stipend and access to virtual fitness classes.

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 Senior Claims Customer Service Representative. Together, we’ll transform the way seniors experience healthcare, ensuring they receive the support and dignity they deserve.