Bilingual Spanish Commercial Health Call Center Representative
New
Eligible candidates also must live in/work from the United States in either the CST or EST time zone., CST or ESTFull-TimeMiddle
Salary not disclosed
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Job Details
- Languages
- Spanish, English
- Experience
- Minimum of 2 years
- Required Skills
- SalesforceCustomer serviceMicrosoft Office
Requirements
- 2 years of customer service experience supporting a commercial health plan.
- Experience with Claims, Medical Management, and Appeals and Grievance units.
- Knowledge of insurance terminology (CPT/ICD-10, HCPCS, Revenue Codes).
- Fluency in English and Spanish.
- Proficiency in Microsoft Office Suite.
- Experience with CRM software (Salesforce preferred).
- High-speed internet connection.
- Dedicated private work area.
Responsibilities
- Research, review and respond to inquiries received from members and providers.
- Employ active listening skills to handle difficult calls professionally.
- Manage escalations ensuring accountability and follow-through.
- Leverage company policies, benefits, claims, and eligibility information for accurate responses.
- Handle member complaints and complaint appeals.
- Coordinate problem solving with internal departments and vendors.
- Interpret billing guidelines and claims inquiries.
- Accurately document all calls.
- Recognize call trends and suggest solutions to leadership.
- Meet production and quality standards.
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