Bilingual Call Center Representative

This is a fully remote position, open to applicants in Louisiana, +12 more states.

📋 Description

• Manage both inbound and outbound customer calls while complying with internal service-level standards.

• Generate and follow up on Long-Term Care leads and opportunities in Salesforce for a period of up to 90 days.

• Create and track Personal Care service requests for the Mainstream population in Salesforce for up to 30 days.

• Respond to calls and make outbound calls in accordance with approved scripts.

• Utilize ePACEs to verify Medicaid eligibility, exclusions, and exemption codes.

• Search Marx (CMS) for Medicare eligibility, enrollments, and special election details.

• Meet daily, weekly, and monthly growth targets.

• Handle calls efficiently to enhance productivity and operational effectiveness.

• Connect consumers seeking personal care or long-term care services with the State broker for initial evaluations.

• Schedule appointments for field and tele-video conferences for SHP Intake Nurses, HF CompleteCare Specialists, and Intake Nurses in Salesforce.

• Arrange appointments for Entitlement Advocates for prospective members facing Medicaid coverage issues or restrictions.

• Schedule Clinical Assessors to conduct Community Health Assessments for Mainstream/HARP members requesting Personal Care Services at home.

• Record incoming and outbound calls in Salesforce call tracking.

• Document outcomes in the pre-enrollment database system.

• Note special instructions in Salesforce.

• Coordinate fulfillment kits and brochures for prospective members.

• Troubleshoot and follow up on long-term care enrollment denials.

• Occasionally work weekends and additional hours before or after scheduled shifts as required.

• Gain a comprehensive understanding of the Division’s impact on Healthfirst plans and members.

• Build trust, exhibit product knowledge and credibility, and maximize scheduled appointments to meet objectives.

• Perform additional responsibilities as assigned.

⛳️ Requirements

• High school diploma or GED.

• Proficiency in reading and speaking both English and Spanish.

• Experience in Member / Customer Service.

• Availability to work an 8 ½ hour shift based on business requirements within specified operating hours.

• Occasional overtime may be necessary.

• Ability to work in a remote setting with a dependable internet connection.

• Strong computer skills, including proficiency in Microsoft Office Suite: Outlook, Excel, Word, PowerPoint.

• Highly organized, capable of multitasking, and detail-oriented.

• Understanding and sensitivity to cultural differences and community needs.

• Ability to thrive in a fast-paced, dynamic, high-stress environment while meeting quota expectations.

• Proficient in communicating and engaging with leaders through virtual platforms, including email and MS Teams.

• Preferred: experience in the healthcare industry.

• Preferred: familiarity with Medicare or Medicaid managed care plan products.

• Preferred: an associate degree or higher from an accredited institution.

• Preferred: extensive experience in inbound and outbound call center roles with telemarketing responsibilities in healthcare.

• Preferred: knowledge of Healthfirst products.

• Preferred: experience interacting with frail adults or elderly populations.

• Preferred: understanding of integrated care principles.

• Preferred: background in health insurance, home care, acute, sub-acute, long-term care, or managed long-term care settings.

• Preferred: experience in managing member information or appointments in a shared network environment utilizing paperless database modules.

• Preferred: experience operating within a multicultural work environment and community.

• Ability to maintain a calm and neutral demeanor while managing numerous details in a distracting environment.

🏝️ Benefits

• Medical, dental, and vision insurance.

• Incentive and recognition programs.

• Life insurance coverage.

• 401k contributions.

• Competitive compensation and comprehensive benefits package.