Customer Service Representative
1 week ago
The Customer Service Representative plays a vital role in assisting members, physicians, hospitals, and other healthcare providers with benefits, eligibility, claims inquiry, and appeals. This position requires strong communication skills, attention to detail, and the ability to work in a fast-paced environment.
Key Responsibilities- Handle inbound calls from members, medical providers, and others, providing accurate and empathetic responses to their inquiries.
- Adjust claims accurately, if needed, and ensure first contact resolution when possible.
- Listen to and address customer needs and concerns, using decision-support tools to provide accurate responses.
- Update customer files and communicate effectively with teams, transferring misdirected requests and offering solutions to non-routine issues.
- Contribute to customer satisfaction and business improvement, adapting responses to caller understanding and educating callers on relevant information.
- Support projects and other departments as directed by management, using strong problem-solving abilities and effective communication skills.
- High School diploma with some college or business school education preferred.
- Basic computer operations knowledge and intermediate proficiency in Microsoft Office (Word, Excel, Access, PowerPoint, Outlook).
- Strong time management skills, general knowledge of HIPAA Confidentiality laws, and quick learning ability to grasp managed care procedures and claims payment policies.
- Detail-oriented and dependable, with effective listening and responding skills, flexibility, and adaptability to changes.
- Excellent attendance and punctuality, comfortable performing tasks at a computer/telephone station, and effective communication through various channels.
Brighton Health Plan Solutions is a healthcare enablement company that partners with self-insured employers, Taft-Hartley Trusts, health systems, providers, and other TPAs to solve the problems facing today's healthcare. Our unique perspective stems from decades of health plan management expertise, proprietary provider networks, and innovative technology platforms.
We are committed to increasing diversity, inclusion, and a sense of belonging at every level, encouraging all team members to bring their authentic selves to work with all of their unique abilities. We respect how you experience the world and welcome you to bring the fullness of your lived experience into the workplace.
At Brighton Health Plan Solutions, we are transforming the health plan experience with the promise of turning today's challenges into tomorrow's solutions. Join us in our mission to redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.
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