Senior Customer Service & Claims Authorization Specialist – Remote, Full‑Time – Driving Patient Outcomes, Care Coordination, and Health Plan Excellence at brighthush – Leading HealthTech Innovator

About brighthush – Pioneering HealthTech for a Healthier Tomorrow

brighthush is a trailblazing global health‑care technology partner that empowers millions of people to live healthier, happier lives. By fusing cutting‑edge data analytics, pharmacy benefit solutions, and patient‑centric services, we help health plans, providers, and members navigate the complex world of health insurance with confidence and clarity. Our mission is simple yet profound: to make health optimization accessible to everyone, everywhere.

Why brighthush? – A Mission‑Driven, Innovative Workplace

In an era where health care is increasingly data‑driven and patient‑centered, brighthush stands at the intersection of technology and compassion. We build tools that translate complex medical information into actionable insights, streamline administrative workflows, and ultimately reduce the burden on patients and providers alike. When you join brighthush, you become part of a movement that is reshaping the future of health care, one interaction at a time.

What sets us apart? We combine industry expertise with a relentless focus on user experience. Our team is made up of data scientists, clinicians, software engineers, and customer service specialists who all share a common goal: to streamline the patient journey and reduce administrative friction. This unique blend of skills means you’ll be working on projects that have real, measurable impact on people’s lives.

Your Role – Senior Customer Service & Claims Authorization Specialist

As a remote, full‑time member of our customer service team, you will be the frontline advocate for patients, providers, and health plans. Your daily interactions will directly influence care coordination, claim accuracy, and overall member satisfaction. You will:

Key Responsibilities – Your Impact in Action

• Customer Interaction & Issue Resolution: Handle inbound calls from members, physicians, and health plans, addressing concerns related to claims, authorizations, and IPA (Independent Practice Association) processes. Provide clear, concise, and compassionate guidance.
• Claims & Authorization Expertise: Review, process, and resolve Medicare, HMO, PPO, and other health plan claims and authorization requests in accordance with corporate guidelines. Ensure accuracy and compliance at every step.
• Contract Interpretation: Analyze provider and health plan contracts to ensure accurate, compliant responses to inquiries. Translate complex contractual language into actionable insights.
• Data Management & Documentation: Log all customer interactions and issue tickets into the Customer Service Tracking database, ensuring traceability, audit readiness, and timely follow‑up.
• Workflow Optimization: Plan and prioritize daily workload to meet quality and turnaround time metrics. Identify bottlenecks and propose process improvements.
• Quality Assurance & Continuous Improvement: Participate in telephonic surveys and quality audits to maintain high standards of service. Identify trends, root causes, and recommend corrective actions.
• Team Collaboration & Mentorship: Shadow new hires, provide mentorship, and share best practices with peers.

Essential Qualifications – What We’re Looking For

• Minimum of 3–5 years of experience in a customer‑service or claims‑processing role within the health‑care or insurance industry.
• Strong knowledge of Medicare, HMO, PPO, and other health plan claim structures and authorization workflows.
• Proficiency with customer‑service platforms and data‑entry tools.
• Excellent verbal and written communication skills, with the ability to explain complex concepts in simple terms.
• High level of attention to detail and a commitment to accuracy and compliance.
• Self‑motivated, proactive, and comfortable working independently in a remote environment.
• Strong analytical and problem‑solving skills, with a knack for identifying process inefficiencies.

Preferred Qualifications – Bonus Points

• Experience with IPA (Independent Practice Association) contracts and provider‑network management.
• Knowledge of pharmacy benefit management processes and medication authorization workflows.
• Familiarity with data‑analytics tools and the ability to generate actionable insights from data.
• Previous experience in a leadership or mentorship capacity within a customer‑service team.
• Certification in health‑care customer service or claims processing (e.g., Certified Professional in Healthcare Quality).

Core Competencies – The DNA of Success at brighthush

• Customer‑Centric Mindset: A genuine passion for helping people navigate the health‑care system.
• Technical Proficiency: Comfortable learning new software, platforms, and data‑analysis tools quickly.
• Communication Excellence: Clear, concise, and empathetic communication across multiple channels.
• Analytical Thinking: Ability to dissect complex problems and propose data‑driven solutions.
• Adaptability: Thrive in a fast‑changing environment with evolving policies and technologies.
• Team Collaboration: Work seamlessly with cross‑functional teams, including data scientists, clinicians, and product managers.
• Time Management: Prioritize tasks effectively to meet or exceed performance metrics.

Career Growth & Learning Opportunities

At brighthush, your professional development is a top priority. We offer:

• Structured mentorship programs that pair you with senior leaders in customer service and claims processing.
• Access to continuous learning resources, including webinars, industry conferences, and online courses.
• Clear career pathways that allow you to progress from Senior Specialist to Team Lead, Manager, or even cross‑functional roles in product or data analytics.
• Regular performance reviews that focus on skill enhancement and goal setting.

Work Environment & Culture – Remote, Inclusive, and Empowering

Our remote‑first culture means you can work from anywhere while staying connected to a vibrant, global team. We foster:

• Weekly virtual town halls where leadership shares company updates and celebrates wins.
• Monthly “Innovation Fridays” where employees pitch new ideas that could shape our product roadmap.
• A culture of psychological safety, where every voice is heard and valued.
• Flexible work hours that respect your personal life and promote work‑life balance.
• Regular virtual team‑building activities, from trivia nights to wellness challenges.

Compensation, Perks, and Benefits

While specific figures vary based on experience, we offer a competitive salary package that includes:

• Base salary commensurate with industry standards for senior customer‑service roles.
• Performance‑based bonuses tied to quality metrics and customer satisfaction scores.
• Comprehensive health, dental, and vision insurance plans for you and your dependents.
• 401(k) matching program to help you build a secure financial future.
• Unlimited paid time off (PTO) and a generous holiday schedule.
• Monthly stipend for home‑office equipment and high‑speed internet.
• Access to mental‑health resources, including counseling and wellness apps.
• Professional development budget to support certifications, conferences, and courses.

Join Us – Make a Difference Every Day

If you are passionate about improving patient outcomes, streamlining claims processes, and delivering exceptional customer service, we want to hear from you. At brighthush, you’ll have the opportunity to work with cutting‑edge technology, collaborate with industry experts, and directly impact the lives of millions of people.

Ready to take the next step in your career? Apply now and become a vital part of the brighthush family.