Member Services Associate

2 weeks ago

New York, New York, United States Brighton Health Plan Solutions Full time
Position Overview

The Client Support Specialist plays a vital role in assisting members, healthcare providers, and other stakeholders with inquiries related to member benefits, eligibility, and claims. This position requires flexibility to work various shifts from Monday to Friday between the hours of 9AM - 7PM EST, with the ability to adapt shifts as necessary based on operational needs.

Key Responsibilities
  • Manage incoming calls from members and healthcare professionals.
  • Accurately process claims adjustments when required.
  • Listen attentively to customer concerns and respond with empathy.
  • Provide information regarding fee structures, network participation, and requirements.
  • Aim for first contact resolution whenever feasible.
  • Maintain and update customer records while ensuring effective communication with team members.
  • Redirect misrouted inquiries and propose solutions for complex issues.
  • Contribute to overall customer satisfaction and organizational improvement.
  • Utilize decision-support tools to deliver precise information.
  • Investigate inquiries using available training and systems.
  • Tailor responses to ensure caller comprehension.
  • Educate callers and confirm their understanding of the information provided.
  • Assist with projects and collaborate with other departments as directed by leadership.
Essential Qualifications

The ideal candidate will possess experience in a high-volume call center environment, familiarity with claims inquiries and review processes, and knowledge of medical specialties and call center operations. Previous experience in a medical office, clinic, or hospital setting is preferred.
  • High School diploma with some college or business school education is preferred.
  • Basic knowledge of computer operations.
  • Intermediate skills in Microsoft Office Suite (Word, Excel, Access, PowerPoint, Outlook).
  • Strong organizational and time management abilities.
  • General understanding of HIPAA confidentiality regulations.
  • Quick learner with the capacity to understand managed care procedures and claims payment policies.
  • Detail-oriented and reliable.
  • Effective listening and communication skills.
  • Adaptable to change with strong conceptual thinking.
  • Proficient problem-solving skills.
  • Consistent attendance and punctuality.
  • Comfortable working at a computer and telephone station.
  • Proficient in various communication channels, including email and chat.
  • Experience with multi-channel communication is a plus.
About Brighton Health Plan Solutions

At Brighton Health Plan Solutions, LLC, we are dedicated to enhancing the accessibility and delivery of healthcare. Joining our team means becoming part of a diverse and inclusive culture that values respect and encourages individual authenticity.

We partner with self-insured employers, health systems, and other organizations to address the challenges of modern healthcare through our innovative third-party administration services. Our extensive experience in health plan management, proprietary provider networks, and advanced technology solutions empower us to improve member experiences and health outcomes. Together with our partners, we are committed to transforming the health plan landscape, turning current challenges into future solutions.

Company Mission

To revolutionize the health plan experience by delivering exceptional products and services to our partners.

Company Vision

To redefine healthcare quality and value by aligning the interests of our partners in unique and impactful ways.

Diversity, Equity, and Inclusion Commitment

At BHPS, we invite all team members to express their authentic selves and bring their unique perspectives to the workplace. We are dedicated to fostering a culture that prioritizes diversity, inclusion, and a sense of belonging at every level.

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