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Customer Service Representative

Brighton Health Plan Solutions, LLC
Westbury, NY
  • Posted: over a month ago
  • Full-Time
Job Description

About This Role:

The Customer Service Representative assists physicians, hospitals, revenue agencies and other healthcare providers with member eligibility, claims inquiry, claim reconsiderations and appeals. The Customer Service Representatives must be able to work in various shifts Monday to Friday between the hours of 9AM – 6PM EST with the ability to adjust shifts with notice based on business needs. This is a remote position.

Primary Responsibilities:

  • The Customer Service Representative will handle inbound calls from physicians, hospitals and other medical provider representatives.
  • Greet customers in a courteous, friendly, and professional manner using agreed upon procedures.
  • Adjust claims requiring minor steps to reprocess accurately.
  • Perform simple claim adjustments as needed.
  • Listen attentively to customer needs and concerns; demonstrate empathy and offer solutions.
  • Answer questions on fee schedules, network participation and general requirements.
  • Clarify customer requirements; probe for and confirm understanding of requirements or problem.
  • Meet customer requirements through first contact resolution, where possible.
  • Confirm customer understanding of the solution and provide additional customer education as needed.
  • Prepare complete and accurate work and update customer file.
  • Communicate effectively with individuals/teams in the program to ensure high quality and timely expedition of customer requests.
  • Effectively transfer misdirected customer requests to an appropriate party and provides accurate contact center numbers to callers.
  • Contribute ideas on ways to resolve problems to better serve the customer and/or improve productivity.
  • Participate in activities designed to improve customer satisfaction and business performance.
  • Use decision-support tools to answer questions, where needed.
  • Solve problems that are sometimes unstructured and that may require reliance on conceptual thinking.
  • Offer solutions to issues that are often non-standard/non-routine and require some clarification.
  • Perform other call center functions and support projects as directed by the management
  • Maintain broad knowledge of client products and services.
  • To properly respond to callers the CSR will utilize knowledge gained in new hire and continuing education coaching and training and three or more systems to investigate the caller’s inquiry and accurately respond in an efficient and timely manner.
  • This requires the CSR to balance the demands of the caller with program requirements for quality, average handle time and productivity.
  • With little to no script guidance, the CSR will have to use appropriate verbiage and level of detail to formulate and adapt the response to the level of understanding the caller has about the Brighton Health Plan Solutions/MagnaCare processes and specific plan details.
  • Calls will require the CSR to proactively educate the caller and validate understanding before completing the call.
  • Support projects and other departments in completing tasks when directed by management.

Essential Qualifications:

The successful candidate will have experience in a high volume call center, experience with claims inquiry and claims review procedures, knowledge of medical specialties, fee schedules, complaints and appeals and call center responsibilities. Previous experience in a physician’s office, group practice, clinic or hospital based practices.

  • High School diploma
  • Some college or business school education is a plus.
  • Knowledge of basic computer operations.
  • Intermediate knowledge of Microsoft Office including Word, Excel, Access, PowerPoint2+ and Outlook.
  • Strong time management skills.
  • Knowledge of CPT codes, ICD-9 Ability to learn quickly.
  • Knowledge of managed care procedures, claims payment policies.
  • Courteous with strong customer service orientation.
  • Dependable with proficient attention to detail.
  • Good listening and responding skills.
  • Must be flexible with the ability to adapt to changes quickly and think conceptually.
  • Solid problem solving skills.
  • Excellent attendance, punctuality and work record required.
  • Ability to perform hand activity work at a computer/telephone station in an office environment.
  • Ability to effectively communicate through multiple channels—specifically email and chat in addition to voice.
  • Previous multi-channel experience (i.e. voice, email, and chat) a plus.

At Brighton Health Plan Solutions (BHPS), we’re creating something new and different in health care, and we’d love for you to be part of it. Based in New York City, BHPS is a rapidly growing, entrepreneurial health care enablement company bringing tangible innovation to the health care delivery systems. Our team is committed to transforming how health care is accessed and delivered. We believe that cost, quality, and population health are optimized when people have long term relationships with their health care providers – and that’s why we’re creating new products that today do not exist anywhere in the New York/New Jersey market. With a growing labor business under the well-known MagnaCare brand, the launch of Create - a new marketplace of health systems focused on self-insured commercial health plan sponsors, and a successful Casualty business, we’re fiercely committed to positively impacting our partners.

Company Mission: Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.

Company Vision: Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.

*We are an Equal Opportunity Employer

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Brighton Health Plan Solutions, LLC


Westbury, NY
11590 USA



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