Senior Remote Healthcare Customer Service Representative – Claims & Member Services Specialist – Champion Member Experience & Engagement at brighthush

About brighthush

brighthush is a pioneering health‑tech partner that empowers individuals and organizations to navigate the complex world of healthcare with confidence and clarity. Since our founding in 2003, we have evolved into a trusted provider of digital platform services, delivering seamless, data‑driven solutions that enhance member experience, streamline claims processing, and support clinical teams across the United States. With a dedicated workforce of 201‑500 professionals, we are headquartered in Rockville, Maryland, and operate from 11 regions across the DMV area, ensuring that every member receives the same high level of care and support, no matter where they are.

Our mission is simple yet powerful: to transform the way people experience health care by putting technology in the hands of those who need it most. We achieve this by building intuitive platforms, fostering collaboration across disciplines, and continuously iterating on our products to meet the evolving needs of the industry.

Why brighthush?

At brighthush, we believe that technology should serve people, not the other way around. Our culture is built on collaboration, continuous learning, and a relentless focus on customer outcomes. We invest in our people through mentorship programs, cross‑functional training, and access to industry‑leading certifications. Whether you’re a seasoned professional or just starting your career, brighthush offers a dynamic environment where your voice matters and your growth is our priority.

Key reasons to join us:

• Innovation at Scale: Work on products that touch millions of members across the country.
• Impactful Work: Every interaction you handle directly improves member satisfaction and health outcomes.
• Career Momentum: Clear promotion pathways and a culture that rewards initiative.
• Remote Flexibility: Fully remote work with the support of a vibrant virtual community.
• Diversity & Inclusion: A workplace where every voice is heard and celebrated.

Role Overview

As a Senior Remote Healthcare Customer Service Representative – Claims & Member Services Specialist, you will be the frontline advocate for our members, ensuring they receive accurate, timely, and compassionate support for all their healthcare inquiries. Your day‑to‑day responsibilities will span claims resolution, enrollment assistance, billing clarification, and benefits education. You will collaborate closely with internal teams, clinical professionals, and external partners to deliver a seamless experience that reflects brighthush’s commitment to excellence.

In this role, you will:

• Serve as the first point of contact for members seeking assistance with claims, benefits, enrollment, and billing.
• Leverage our advanced CRM and claims platforms to diagnose issues and provide solutions.
• Maintain a high first‑contact resolution rate while ensuring compliance with regulatory standards.
• Act as a liaison between members, payers, and internal stakeholders to expedite claim adjudication.
• Educate members on plan benefits, coverage nuances, and cost‑sharing responsibilities.

Key Responsibilities

• Member Support: Respond to inbound member inquiries via phone, email, and chat regarding benefits, claims status, enrollment, billing, and policy details.
• Issue Resolution: Investigate and resolve service issues, escalating complex cases to the appropriate specialists while maintaining a high first‑contact resolution rate.
• Claims Management: Review submitted claims, verify processing requirements, identify payment discrepancies, and coordinate with payers to ensure accurate and timely reimbursement.
• Enrollment & Billing: Facilitate enrollment transactions, update member records, and manage billing activities in accordance with established guidelines and regulatory standards.
• Education & Outreach: Educate members, providers, and group administrators on benefits, contractual provisions, and procedural steps, ensuring they understand their rights and responsibilities.
• Documentation: Maintain meticulous records of all customer interactions, actions taken, and outcomes in our CRM system, adhering to data privacy and quality standards.
• Multi‑System Navigation: Operate multiple software applications simultaneously—such as claims processing platforms, enrollment portals, and internal knowledge bases—while delivering exceptional service.
• Cross‑Functional Collaboration: Work closely with internal teams (claims, enrollment, billing) and clinical professionals to support managed care interventions and improve member outcomes.

Essential Qualifications

• High school diploma or GED (or equivalent).
• Minimum of 1 year of experience in customer service, claims processing, or inbound call center operations.
• Prior exposure to healthcare, health insurance, medical information, or claims‑related workflows.
• Strong verbal and written communication skills, with the ability to explain complex concepts in simple terms.
• Excellent problem‑solving, organizational, and time‑management abilities.
• Self‑motivated and capable of working independently in a remote, fast‑paced, quality‑driven environment.
• Proficiency in Microsoft Office, email, internet research, and navigating multiple software applications.

Preferred Qualifications

• 2–5 years of inbound call center experience, preferably within the healthcare sector.
• Experience with claims adjudication systems and enrollment portals.
• Knowledge of HIPAA regulations and data privacy best practices.
• Familiarity with managed care terminology and benefit plan structures.
• Demonstrated ability to handle high call volumes while maintaining accuracy and empathy.

Skills & Competencies

• Customer‑Centric Mindset: Passion for helping people navigate their healthcare journey.
• Analytical Thinking: Ability to dissect complex claims and billing scenarios to identify root causes.
• Attention to Detail: Precision in data entry, documentation, and compliance checks.
• Adaptability: Comfortable with evolving processes, new technologies, and changing regulatory landscapes.
• Team Collaboration: Willingness to partner with cross‑functional teams to resolve issues and improve service.
• Technology Savvy: Quick learner of new software and platforms, with a knack for troubleshooting.

Career Growth & Learning Opportunities

At brighthush, your career trajectory is as dynamic as the industry we serve. We offer:

• Structured onboarding and continuous training programs covering claims processing, enrollment systems, and customer service best practices.
• Mentorship from senior representatives and subject‑matter experts.
• Access to industry certifications (e.g., Certified Professional Coder, Certified Claims Specialist).
• Clear promotion pathways to roles such as Senior Claims Analyst, Enrollment Specialist, or Team Lead.
• Opportunities to transition into clinical support, data analytics, or product development teams.

Work Environment & Culture

Working remotely from the comfort of your own space, you’ll still feel part of a vibrant, collaborative community. Our culture is defined by:

• Regular virtual town halls and team‑building events.
• Open communication channels—Slack, Teams, and weekly check‑ins with managers.
• A focus on work‑life balance, with flexible scheduling to accommodate personal commitments.
• Recognition programs that celebrate achievements and milestones.
• A commitment to diversity, equity, and inclusion—ensuring every voice is heard.

Compensation & Benefits

While specific salary ranges are tailored to experience and location, brighthush offers a competitive compensation package that includes:

• Base salary commensurate with industry standards.
• Performance‑based bonuses and incentive programs.
• Comprehensive health, dental, and vision insurance.
• 401(k) retirement plan with company match.
• Paid time off, holidays, and sick leave.
• Professional development stipend and tuition reimbursement.
• Wellness resources—virtual fitness classes, mental health support, and wellness challenges.
• Fully remote work setup stipend for home office equipment.

How to Apply

If you are a dedicated, customer‑focused professional eager to make a tangible impact in the healthcare space, we want to hear from you. Submit your application through the link below and join a team that values innovation, empathy, and excellence.

Apply to This Job

Closing Statement

At brighthush, we’re not just filling a role—we’re building a future where every member feels heard, supported, and empowered. If you thrive in a remote, fast‑paced environment and are passionate about delivering top‑notch service to healthcare members, this is the place for you. Bring your expertise, your curiosity, and your commitment to excellence, and help us transform the way people experience health care. Apply today and start your journey with brighthush.