[Remote] Eligibility Service Representative

Note: The job is a remote job and is open to candidates in USA. Brighton Health Plan Solutions (BHPS) is seeking an Eligibility Service Representative (ESR) who is experienced in understanding eligibility and communicating through various multi-channel features. The ESR will assist in issue resolution related to eligibility, changes to coverage, and support the Eligibility & Benefits team.

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

Skills

• 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

Company Overview