Bilingual 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 of customer service experience supporting a commercial health plan
- Required Skills
- SalesforceCustomer serviceMicrosoft OfficeCRM
Requirements
- Minimum of 2 years of customer service experience supporting a commercial health plan.
- Experience collaborating with Claims, Medical Management, and Appeals and Grievance units.
- Knowledge of medical and insurance terminology (CPT/ICD-10, HCPCS, Revenue Codes).
- Fluency in English and Spanish.
- Proficiency in Microsoft Office (Word, Excel, Outlook, OneNote).
- Prior experience using a CRM (SalesForce preferred).
- High-speed internet connection.
- Dedicated work area separate from other living areas.
Responsibilities
- Research, review and respond to inquiries received from members and providers.
- Handle inbound and outbound calls and respond to email inquiries.
- Manage escalations ensuring accountability and follow through to closure.
- Leverage company policies, benefits, claims, and eligibility to respond accurately.
- Handle member complaints and complaint appeals.
- Coordinate problem solving with internal departments, vendors, and providers.
- Interpret billing guidelines and inquiries related to claims and claim payments.
- Accurately document all calls.
- Analyze trends and patterns and suggest solutions to leadership.
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