Senior Remote Customer Care Specialist – Health & Vision Benefits Champion – Expert in Complex Claims Resolution, Member Outcome Optimization, and Continuous Process Improvement at brighthush

About brighthush and the Future of Health & Vision Care

In today’s rapidly evolving healthcare landscape, families and individuals are seeking more than just coverage—they want clarity, compassion, and convenience. brighthush is at the forefront of this transformation, blending cutting‑edge artificial intelligence, predictive analytics, and a relentless customer‑first philosophy to turn complex medical, dental, and vision benefits into a seamless, transparent experience. Our mission is simple: empower every member to navigate their health journey with confidence and ease.

Why You’ll Love Working at brighthush

At brighthush, we believe that the best outcomes for our members come from empowered, passionate teams. Our culture thrives on collaboration, continuous learning, and an unwavering commitment to service excellence. Every team member is a vital contributor to the future of healthcare, and we reward that dedication with:

• Fully Remote Flexibility: Work from anywhere in the country and enjoy a schedule that adapts to your lifestyle.
• Dynamic Growth Path: Begin as a Customer Care Representative and advance to Senior Support Specialist, Team Lead, or Manager roles.
• Impactful Work: Every call you handle directly improves a member’s experience and helps them navigate complex benefit landscapes.
• Competitive Compensation: Base pay plus differential for high‑traffic days, with opportunities for overtime and seasonal bonuses.
• Comprehensive Benefits: Health, dental, vision, and wellness programs for you and your family.
• Learning & Development: Access to online courses, certifications, and mentorship programs to sharpen your skills.
• Inclusive Culture: A community that celebrates diversity, promotes equity, and values every voice.
• Work‑Life Balance: Flexible hours, generous paid time off, and a supportive environment that respects your personal commitments.

Role Overview

As a seasoned Senior Remote Customer Care Specialist, you will serve as the frontline advocate for our members and providers. Your role blends deep product knowledge with exceptional communication skills to resolve inquiries, troubleshoot issues, and guide members through their health and vision journeys. You will be the bridge between members, providers, and internal teams, ensuring seamless service delivery and fostering trust in every interaction.

Key Responsibilities

• Answer inbound calls from dental and vision members regarding eligibility, benefit coverage, authorizations, claims, and provider location searches.
• Apply knowledge of claim adjustments and resubmission processes to resolve provider requests efficiently.
• Communicate high‑level claim issues to Provider Relations staff, ensuring timely reimbursement and conflict resolution.
• Assist with enrollment activities such as assigning primary care providers and updating third‑party insurance information.
• Serve as the liaison between brighthush and client Member Services teams to resolve eligibility questions, appeals, and grievances.
• Provide status updates to providers about credentialing applications and encourage the use of our provider web portal for self‑service.
• Ensure all calls adhere to brighthush and client guidelines, documenting interactions accurately in our internal systems.
• Utilize effective diffusion techniques to make members feel heard, valued, and supported.
• Escalate complex issues to leadership when necessary, maintaining a high standard of service quality.
• Track and report on key performance metrics such as average handle time, first‑contact resolution, and member satisfaction scores.
• Participate in daily huddles and weekly team meetings to share insights, challenges, and best practices.
• Maintain up‑to‑date knowledge of policy changes, benefit updates, and regulatory requirements that impact member experience.

Additional Responsibilities

• Recommend system enhancements and process improvements to management based on frontline insights.
• Keep the Provider Relations team informed of manual discrepancies, location changes, or other provider‑related issues.
• Participate in departmental projects, contributing to continuous improvement initiatives.
• Mentor new hires and provide on‑the‑job coaching to elevate team performance.
• Support quality assurance efforts by reviewing recorded calls and providing constructive feedback.
• Collaborate with the technology team to troubleshoot and resolve system outages or performance issues.

Essential Qualifications

• High school diploma or equivalent.
• Minimum of 1 year of customer service experience in healthcare, call center, banking, or retail environments.
• Proficiency with Microsoft Office (Word, Excel, Outlook) and comfortable navigating multiple software platforms.
• Strong typing and data entry skills, with a keen eye for detail.
• Excellent listening and communication abilities, with a natural empathy for customers.
• Critical thinking skills to analyze requests quickly and provide appropriate solutions.
• Ability to work occasional overtime, including evenings, weekends, and holidays during peak periods such as the Annual Medicare Open Enrollment (Oct 1 – Mar 31).
• Strong multitasking and navigation skills to manage multiple calls and systems simultaneously.
• Basic understanding of health insurance terminology and processes.

Preferred Qualifications

• 1+ years of customer service experience specifically within the dental, vision, or medical insurance industry.
• Prior experience working in a virtual or remote environment.
• Familiarity with dental, vision, and/or medical insurance terminology and processes.
• Experience with provider credentialing, claim adjudication, or enrollment systems.
• Knowledge of HIPAA regulations and data privacy best practices.
• Experience using CRM and call‑center software such as brighthush, brighthush, or brighthush.

Skills & Competencies

• Customer‑centric mindset with a passion for problem solving.
• Strong verbal and written communication skills in English.
• Proficiency in using CRM and call‑center software.
• Adaptability to changing priorities and a fast‑paced environment.
• Team player who collaborates across departments to achieve shared goals.
• Self‑motivated and disciplined, thriving in a remote work setting.
• Analytical mindset with the ability to interpret data and drive actionable insights.
• Resilience under pressure, maintaining composure during high‑volume periods.

Career Growth & Learning Opportunities

At brighthush, we invest in your professional journey. As you gain experience, you’ll have the chance to:

• Advance to Senior Customer Care Specialist, handling more complex cases and mentoring new hires.
• Transition into a Team Lead role, overseeing a group of representatives and shaping service strategies.
• Move into a Managerial position, driving operational excellence and influencing company‑wide initiatives.
• Earn industry certifications such as Certified Customer Service Professional (CCSP) or Certified Health Insurance Associate (CHIA).
• Participate in cross‑functional projects that impact product development, provider relations, and member experience.
• Attend annual conferences, webinars, and workshops to stay ahead of industry trends.
• Leverage our internal learning platform to pursue courses in data analytics, project management, and leadership.

Work Environment & Culture

brighthush fosters a culture of inclusion, transparency, and innovation. Our remote teams collaborate through real‑time chat, video meetings, and shared project boards. We celebrate successes with virtual team events, recognition programs, and a commitment to work‑life balance.

Our values center on:

• Integrity: Honesty and transparency guide every decision.
• Excellence: We strive for the highest quality in service and solutions.
• Collaboration: Teamwork across functions drives our success.
• Growth: Continuous learning and development are integral to our culture.
• Empathy: We put ourselves in our members’ shoes to deliver compassionate support.

We also champion mental and physical well‑being through wellness programs, virtual fitness classes, and mindfulness resources. Your remote workspace is fully equipped with ergonomic support and a stipend for home office upgrades.

Compensation & Perks

While specific figures may vary, you can expect:

• Competitive hourly wage with a $2.00 differential for Monday and Tuesday shifts.
• Opportunities for overtime, especially during peak enrollment periods.
• Health, dental, and vision insurance plans for you and your dependents.
• Paid time off, including holidays, sick leave, and personal days.
• 401(k) retirement plan with company match.
• Wellness stipend for gym memberships, meditation apps, or other health‑related expenses.
• Access to an extensive library of online learning resources and tuition reimbursement for relevant courses.
• Employee assistance program (EAP) for confidential counseling and support.
• Annual performance bonuses tied to team and individual metrics.
• Flexible work schedule and remote work stipend.

How to Apply

Ready to make a difference in people’s health journeys? Click the link below to submit your application and join the brighthush family. We’re excited to learn how your skills and passion align with our mission.