Customer Service Representative
14 hours ago
The Customer Service Representative plays a vital role in assisting members, physicians, hospitals, and other healthcare providers with member 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.
- Adjust claims accurately, if needed.
- Listen to and address customer needs and concerns empathetically.
- Answer questions about fee schedules, network participation, and requirements.
- Ensure first contact resolution when possible.
- Update customer files and communicate effectively with teams.
- Transfer misdirected requests and offer solutions to non-routine issues.
- Contribute to customer satisfaction and business improvement.
- Use decision-support tools to provide accurate responses.
- Investigate inquiries using training and systems.
- Adapt responses to caller understanding.
- Educate callers and validate their understanding.
- Support projects and other departments as directed by management.
- High School diploma with some college or business school education preferred.
- Basic computer operations knowledge.
- Intermediate proficiency in Microsoft Office (Word, Excel, Access, PowerPoint, Outlook).
- Strong time management skills.
- General knowledge of HIPAA Confidentiality laws.
- Quick learner with ability to grasp managed care procedures and claims payment policies.
- Detail-oriented and dependable.
- Effective listening and responding skills.
- Flexible and adaptable to changes, with conceptual thinking.
- Strong problem-solving abilities.
- Excellent attendance and punctuality.
- Comfortable performing tasks at a computer/telephone station.
- Effective communication through various channels, including email, chat, and voice.
- Previous multi-channel experience is a plus.
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. We encourage all team members to bring their authentic selves to work with all of their unique abilities.
At Brighton Health Plan Solutions, we are transforming the health plan experience with the promise of turning today's challenges into tomorrow's solutions.
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