Customer Service Specialist- Onsite

About The Role

Brighton Health Plan Solutions seek a detail-oriented and empathetic North Carolina-based Customer Service Specialist to join our team. In this part-time role, you will provide in-person support to our members at an assigned service center location. You will assist customers with member benefits, eligibility, claims inquiries, claim reconsiderations and appeals at the on-site facility. This position requires regular face-to-ace interaction with members and, during periods of lower walk-in volume, will also support customer service inquiries received by phone.

• Working Hours will be Monday through Friday 10am-2pm EST

Brighton Health Plan Solutions seek a detail-oriented and empathetic North Carolina-based Customer Service Specialist to join our team. In this part-time role, you will provide in-person support to our members at an assigned service center location. You will assist customers with member benefits, eligibility, claims inquiries, claim reconsiderations and appeals at the on-site facility. This position requires regular face-to-ace interaction with members and, during periods of lower walk-in volume, will also support customer service inquiries received by phone.

• Working Hours will be Monday through Friday 10am-2pm EST

• Provide timely and professional in-person support to members regarding benefits, eligibility, claims, and appeals
• Handle escalated member concerns, inquiries, and complaints in a professional and timely manner
• Actively listen to customer concerns, demonstrating empathy and offering effective solutions
• Analyze and resolve non-standard and complex issues using critical thinking and problem-solving skills
• Maintain a thorough understanding of health plan benefits, policies, procedures, and client-specific requirements to provide accurate guidance
• Document all interactions and resolutions accurately in the system to ensure seamless customer service
• Adhere to regulatory requirements, company policies, and confidentiality guidelines when handling member information
• Maintains a professional appearance and demeanor that reflects the organization's standards

• Prior customer service experience, preferably in healthcare, insurance, or a related field is required.
• Experience in a walk-in service center or similar environments providing in-person support
• Knowledge of claims review procedures appeals and grievance processes, medical terminology, provider specialties, and fee schedules preferred.
• Strong communication skills with the ability to explain complex information in a clear and empathetic manner
• Ability to manage multiple inquiries while maintaining attention to detail and accuracy
• Problem-solving skills and the ability to navigate complex eligibility and claims issues
• Strong communication skills with the ability to explain complex information in a clear and empathetic manner
• Salesforce experience preferred
• Bilingual preferred
• Ability to de-escalate challenging situations while maintaining a positive member experience
• Intermediate proficiency in Microsoft Office (Word, Excel, Outlook)

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…