Eligibility Service Representative - Mandarin​/Cantonese Speaking

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.

• 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 & analysis 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 elevate 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.

• 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.

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…