Bilingual Commercial Health Call Center Representative (Spanish)
New
E
Evry HealthHealth Insurance
Must live in/work from the United States in either the CST or EST time zone., CST or ESTFull-TimeMiddle
Salary55,000 USD per year
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Job Details
- Languages
- Spanish, English
- Experience
- 2+ years
- Required Skills
- Customer serviceCRM
Requirements
- High school diploma or equivalent.
- 2+ years of customer service experience supporting commercial fully insured health plan business.
- Fluency in English and Spanish.
- Working knowledge of commercial health plan benefits, eligibility, and claims processes.
- Demonstrated knowledge of CPT, ICD-10, HCPCS, and Revenue Codes.
- Proficiency with Microsoft 365.
- Must reside in the United States within CST or EST time zones.
- Must maintain a dedicated, private, and secure work area.
- Must have access to high-speed internet.
Responsibilities
- Research and resolve inbound and outbound member and provider inquiries regarding benefits, eligibility, claims, and billing.
- Meet department metrics including quality, AHT, ASA, and schedule adherence.
- Interpret and explain plan benefits, cost-sharing, and claims payment decisions using CPT, ICD-10, HCPCS, and Revenue Codes.
- Support providers with claim status, prior authorization requirements, and payment details.
- Document escalated situations and interaction details in the company CRM.
- Collaborate cross-functionally with Claims and Medical Management teams to resolve complex issues.
- Assist members with portal navigation and identify recurring call trends for leadership.
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