Bilingual (Spanish) Commercial Health Call Center Representative
New
We will only consider candidates in the United States who reside in the CST or EST time zones., 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 OfficeCRM
Requirements
- Minimum of 2 years of customer service experience supporting a commercial health plan (not just Medicare, Medicaid, or Pharmacy).
- Fluency in both English and Spanish.
- Knowledge of medical and insurance industry terminology including CPT/ICD-10, HCPCS and Revenue Codes.
- Experience collaborating and supporting business and operational units such as Claims, Medical Management and Appeals and Grievance.
- Proficiency in Microsoft Office applications Word, Excel, Outlook, OneNote.
- Prior experience using a CRM, preferably Salesforce.
- Must live in the United States within the CST or EST time zones.
- Dedicated work area established that is separate from other living areas for information privacy.
- Ability to keep all company sensitive documents secure.
- High-speed internet connection/service.
Responsibilities
- Research, review and respond to inquiries received from members and providers.
- Employ active listening skills, demonstrate patience and empathy, and handle difficult calls tactfully, courteously, and professionally.
- Effectively manage escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow through to closure.
- Leverage company policies and procedures, benefits, claims, and eligibility to respond accurately to all inquiries.
- Handle member complaints and complaint appeals.
- Work with internal departments, vendors, business partners, providers, etc. to help coordinate problem solving in an effective and timely manner.
- Demonstrate basic understanding of company billing guidelines and effectively interpret inquiries related to claims and claim payments.
- Accurately document all calls.
- Recognize trends and patterns in call types and engage leadership with suggested solutions.
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