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About the Role

Brighton Health Plan Solutions (BHPS) is seeking an experienced Eligibility Service Representative (ESR) to handle eligibility inquiries, communicate through multiple channels, and resolve issues by following established workflows. The ESR will confirm, identify, and research eligibility and coverage changes, supporting the Eligibility & Benefits team.

Responsibilities

• Receive and resolve caregiver inquiries.
• Collaborate with the Benefits Enrollment team to address eligibility, hours, or co-premium issues, including outreach.
• Demonstrate strong customer service, attention to detail, research, analysis, and issue resolution skills.
• Clarify customer requirements and confirm understanding of problems.
• Manage caregiver requests within required turnaround times, including internal outreach and escalation.
• Communicate effectively with individuals and teams for timely request completion.
• Participate in activities to improve customer satisfaction and business performance.
• Utilize decision-support tools for answering questions.
• Apply critical thinking to solve complex problems and identify escalation needs.
• Perform call center functions, including handling inbound calls and supporting projects.
• Maintain broad knowledge of client requirements, procedures, and key contacts.
• Support projects and other departments as directed by management.

Requirements

• Bilingual in Russian/English or Korean/English.
• Flexible availability for alternate schedules/hours, including shifts between 11AM and 9PM EST, Monday through Friday.
• 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.

Skills

• Eligibility understanding
• Multi-channel communication (phone, chat, email)
• Issue resolution
• Customer service
• Attention to detail
• Research and analysis
• Problem-solving
• Time management
• Investigative skills
• Microsoft Office Suite
• HIPAA Confidentiality

Location

• Remote

Work Type

• Full-time
• Remote

Experience Level

• Experience in high-volume enrollment and eligibility transactions
• Prior high-volume call center experience

Education Level

• High School diploma or GED
• Some college or business school education is advantageous

Salary/Compensations

• $43,000 - $50,000

About the Company

• 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.

Equal Opportunity

• We are an Equal Opportunity Employer