Senior Commercial Health Customer Service Specialist – Remote Advocate for Member & Provider Success, Data‑Driven Claims Support, Digital Self‑Service Champion, Process Improvement & Automation Leader at brighthush

About brighthush

In an era where health‑insurance can feel opaque and impersonal, brighthush is carving a new path. We blend state‑of‑the‑art technology with a deeply human touch to create an experience that feels both efficient and caring. Our mission is simple yet powerful: bring humanity back into health insurance. By empowering members to navigate their benefits with confidence and giving providers the clarity they need to deliver care efficiently, we are redefining what it means to be a health‑insurance partner.

Founded on the belief that every person deserves clear, compassionate, and timely support, brighthush has grown into a national leader in commercial health plans. We serve thousands of members and hundreds of providers across the United States, delivering a suite of benefits that combine affordability, flexibility, and innovation. Our culture is built on transparency, collaboration, and a relentless focus on continuous improvement.

Why Join brighthush?

• Impactful Work: Every call, email, or chat you handle directly improves a member’s experience and supports a provider’s ability to deliver care.
• Remote Flexibility: Work from anywhere in the United States (CST or EST time zones) while enjoying the same benefits and career growth as our on‑site colleagues.
• Growth & Development: Access to internal training, mentorship programs, and cross‑functional projects that accelerate your career trajectory.
• Inclusive Culture: A diverse, supportive environment where every voice is heard and every idea can shape the future of health insurance.
• Competitive Compensation: A comprehensive package that rewards your expertise and dedication.
• Innovation at Scale: Work with the latest tools and platforms that are reshaping the industry.
• Community Impact: Your work directly contributes to healthier communities and more equitable access to care.

Role Overview

As a Senior Commercial Health Customer Service Specialist at brighthush, you will be the frontline advocate for our members and providers. You will manage inbound and outbound communications—calls, emails, and chat—delivering accurate, thorough information on commercial health plan benefits, eligibility, claims, and billing. Your professionalism, empathy, and knowledge will ensure every interaction reflects brighthush’s commitment to accessible, accurate, and compassionate support.

In this role, you will also act as a catalyst for process improvement, data‑driven decision making, and digital self‑service adoption. You will partner with cross‑functional teams to identify trends, streamline workflows, and implement automation that enhances the member experience while reducing operational friction.

Key Responsibilities

• Member & Provider Inquiry Resolution: Research, review, and respond to a wide range of inquiries, using your deep understanding of benefits, eligibility, claims, and billing to resolve issues at first contact whenever possible. Meet all turnaround times and departmental metrics, including quality, average handling time (AHT), average speed of answer (ASA), and schedule adherence.
• Benefits, Eligibility & Claims Explanation: Accurately interpret and explain plan benefits, eligibility, cost‑sharing, and claims payment decisions. Apply working knowledge of CPT, ICD‑10, HCPCS, and Revenue Codes. Provide support to providers on claim status, prior authorization requirements, payment details, and pharmacy or wellness vendor inquiries.
• Escalation Management: Own the initial intake and documentation of escalated member and provider situations, collaborating with Claims, Medical Management, and other internal teams to resolve complex issues.
• Cross‑Functional Collaboration & Documentation: Work closely with Claims, Medical Management, and other departments to resolve intricate cases. Accurately document every interaction in the designated CRM system, ensuring data integrity and audit readiness.
• Trend Recognition & Digital Self‑Service Promotion: Monitor call and inquiry patterns to surface trends to leadership. Assist members with portal navigation and promote long‑term digital self‑sufficiency, reducing future call volume.
• Continuous Improvement: Participate in quality reviews, process improvement initiatives, and training sessions to enhance service delivery and operational efficiency.
• Knowledge Base Enhancement: Contribute to the creation and refinement of internal knowledge articles, FAQs, and training materials based on recurring issues and new product updates.
• Performance Coaching: Mentor junior team members on best practices, escalation protocols, and customer‑centric communication techniques.
• Compliance & Data Security: Adhere to HIPAA regulations and company policies, ensuring all member and provider data is handled with the utmost confidentiality and integrity.
• Technology Adoption: Stay current with new tools, platforms, and automation features introduced by brighthush to streamline workflow and improve customer experience.

Essential Qualifications

• High school diploma or equivalent (preferred: Associate’s or Bachelor’s degree in business, healthcare, or related field).
• Minimum of 2 years of customer service experience supporting a commercial fully insured health plan (not limited to Medicare, Medicaid, or pharmacy).
• Strong working knowledge of commercial health plan benefits, eligibility, and claims processes.
• Demonstrated familiarity with CPT, ICD‑10, HCPCS, and Revenue Codes.
• Proficiency in Microsoft 365 (Word, Excel, Outlook, Teams).
• Excellent verbal and written communication skills in English.
• Ability to work independently in a remote environment, maintaining a dedicated workspace and high‑speed internet connection.
• U.S. residency in either the Central (CST) or Eastern (EST) time zone.

Preferred Qualifications

• Experience supporting Claims, Medical Management, Appeals, or Grievance functions.
• Proficiency with brighthush CRM platform or a comparable system.
• Experience identifying and reporting call trends or serving in an informal team lead/quality capacity.
• Knowledge of HIPAA regulations and data privacy best practices.
• Previous remote work experience with a proven track record of meeting or exceeding performance metrics.
• Certifications in health insurance, claims processing, or customer service excellence.

Skills & Competencies

• Customer‑Centric Mindset: Empathy, patience, and a genuine desire to help members and providers.
• Analytical Thinking: Ability to interpret complex data, identify patterns, and propose actionable solutions.
• Technical Proficiency: Comfortable navigating multiple systems, including CRM, knowledge bases, and internal portals.
• Time Management: Prioritize tasks, manage call queues, and meet strict performance metrics.
• Collaboration: Work effectively across departments, building relationships and fostering teamwork.
• Adaptability: Thrive in a fast‑changing environment, quickly learning new processes and tools.
• Communication Excellence: Clear, concise, and professional communication across all channels.
• Problem‑Solving: Creative and resourceful approach to resolving complex member and provider issues.

Career Growth & Learning Opportunities

At brighthush, we believe in investing in our people. As a Senior Commercial Health Customer Service Specialist, you will have access to:

• Structured onboarding and continuous training programs covering product knowledge, compliance, and soft skills.
• Mentorship from senior team members and leaders across the organization.
• Cross‑functional projects that expose you to Claims, Medical Management, and Product Development.
• Clear career pathways to roles such as Senior Customer Service Specialist, Team Lead, Quality Analyst, or Product Support Manager.
• Regular performance reviews and goal‑setting sessions to align your career aspirations with organizational objectives.
• Opportunities to lead process improvement initiatives and influence the future of customer service at brighthush.
• Access to industry conferences, webinars, and certifications that enhance your professional skill set.

Work Environment & Culture

brighthush’s remote‑first culture means you’ll enjoy the flexibility of working from home while staying connected to a vibrant, collaborative team. We provide:

• Weekly virtual team huddles and monthly all‑hands meetings.
• Access to a digital collaboration hub (Teams, Slack, Confluence).
• Regular virtual social events, wellness challenges, and community service initiatives.
• A culture of transparency, where feedback is encouraged and ideas are valued.
• Inclusive hiring practices that celebrate diversity in all its forms.
• Employee resource groups that foster belonging and professional growth.

Compensation & Benefits

We offer a competitive salary range that reflects your experience and the value you bring to brighthush. In addition, you will receive:

• Comprehensive health, dental, and vision insurance plans.
• Life and disability coverage.
• 401(k) retirement plan with company match.
• Generous paid time off (PTO) and holiday schedule.
• Professional development budget and tuition reimbursement.
• Flexible work hours within the CST or EST time zone to support work‑life balance.
• Technology stipend to support your home office setup.
• Employee assistance program (EAP) for mental health and well‑being support.
• Annual wellness stipend and access to virtual fitness classes.

How to Apply

If you are passionate about delivering exceptional customer service, thrive in a remote setting, and want to be part of a mission‑driven organization, we encourage you to apply today. Submit your resume and a brief cover letter outlining why you’re the perfect fit for brighthush’s Commercial Health Customer Service team.

Join brighthush – Where Compassion Meets Innovation

At brighthush, we’re not just another health‑insurance company. We’re a community of dedicated professionals who believe that every member deserves clear, compassionate, and timely support. Your expertise will help us continue to transform the health‑insurance experience, one interaction at a time. If you’re ready to make a real difference, we can’t wait to meet you.