Eligibility Service Representative

About the Role

Brighton Health Plan Solutions (BHPS) is seeking an Eligibility Service Representative (ESR) who are experienced in understanding eligibility, communicating through various multi-channel features such as phone, chat and email, and following workflows to assist in issue resolution. BHPS shall serve as the client’s eligibility vendor and forward eligibility files to health plans, dental vendors and any other vendor the client utilizes. The ESR will confirm, identify and research matters as they relate to eligibility, changes to coverage and participation as well as support the Eligibility & Benefits team.

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities and activities may change, or new ones may be assigned at any time with or without notice.

Primary Responsibilities

• The ESR will be responsible for receiving and resolving caregiver inquiries.
• Works with the Benefits Enrollment team to review and resolve any eligibility, hours or co-premium issues including follow-up outreach to caregivers Listen attentively to customer needs and concerns; demonstrate empathy and offer solutions.
• Demonstrate strong customer service skills, attention to detail, research & analyzation and issue resolution.
• Clarify customer requirements; probe for and confirm understanding of requirements or problem.
• Agent will be responsible for managing caregiver requests within required turnaround time including conducting outreach to internal partners, engaging the support of the Team Leader and Supervisor as necessary.
• Communicate effectively with individuals/teams to ensure high quality and timely expedition of customer requests.
• Participate in activities designed to improve customer satisfaction and business performance.
• Use decision-support tools to answer questions, where needed.
• Ability to use critical thinking to solve complex problems and identify when to escalate to the appropriate department.
• Performs call center functions including handling inbound calls and support projects as directed by the management.
• Maintain broad knowledge of client requirements, procedures and key contacts.
• Support projects and other departments in completing tasks when directed by management.

Essential Qualifications

• Bilingual in Russian/English or Korean/English.
• Flexible availability for alternate schedules/hours, including shifts between 11AM and 9PM EST, Monday through Friday, with training from 9AM to 6PM.
• Experience in high-volume enrollment and eligibility transactions, premium billing, and collections.
• Knowledge of labor and commercial carrier enrollment procedures.
• Prior high-volume call center experience.
• General knowledge of HIPAA Confidentiality.
• High School diploma or GED.
• Remote work capability with internet access.
• Basic computer skills, including Microsoft Office (Word, Excel, Access, PowerPoint, Outlook).
• Strong investigative and time management skills.
• Courteous and customer-service oriented.
• Detail-oriented and dependable.
• Effective communication through multiple channels (email, chat, voice).
• Preferred experience in enrollment/eligibility roles, especially in commercial and labor plans.
• Previous multi-channel experience (voice, email, chat) is a plus.
• Some college or business school education is advantageous.

About

At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all of your unique abilities.

Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions.

Come be a part of the Brightest Ideas in Healthcare™.

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.

DEI Purpose Statement

At BHPS, we encourage all team members to bring your authentic selves to work with all of your unique abilities. We respect how you experience the world and welcome you to bring the fullness of your lived experience into the workplace. We are building, nurturing and embracing a culture focused on increasing diversity, inclusion and a sense of belonging at every level.

*We are an Equal Opportunity Employer

Annual Salary Range: $43,000 - $50,000

The salary range and/or hourly rate listed is a good faith determination that may be offered to a successful applicant for this position at the time of the posting of an advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable by law including but not limited to location, years of relevant experience, education, credentials, skills, budget and internal equity.