Bilingual, Spanish Commercial Health Call Center Representative

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct research, review, and provide responses to inquiries from members and providers.

• Utilize active listening techniques, exhibit patience and empathy, and manage challenging calls with tact, courtesy, and professionalism.

• Efficiently handle escalations within the department by ensuring accountability, urgency, effective communication, and follow-through until resolution.

• Apply company policies and procedures, as well as information on benefits, claims, and eligibility, to accurately address all inquiries.

• Address member complaints and manage complaint appeals.

• Collaborate with internal departments, vendors, business partners, and providers to facilitate timely and effective problem-solving.

• Demonstrate a fundamental understanding of company billing guidelines and competently interpret inquiries related to claims and payments.

• Ensure accurate documentation of all calls.

• Identify trends and patterns in call types and engage leadership with proposed solutions.

• Achieve and maintain established production and quality standards for the department, both individually and as part of a team.

• Assist members in navigating the member portal while encouraging self-sufficiency with our tools.

• Show personal responsibility and accountability by meeting attendance and schedule adherence expectations.

• Thrive in a virtual work setting through active participation in team huddles, one-on-one meetings with supervisors, instant messaging, and check-ins.

⛳️ Requirements

• At least 2 years of customer service experience in support of a commercial health plan (beyond Medicare, Medicaid, or Pharmacy).

• Experience in collaborating with and supporting business and operational units such as Claims, Medical Management, and Appeals and Grievance.

• Familiarity with medical and insurance industry terminology, including CPT/ICD-10, HCPCS, and Revenue Codes.

• Outstanding communication skills, both verbal and written, with the ability to articulate and explain complex topics to a diverse audience.

• Comfort in a fast-paced, deadline-driven work environment.

• Strong attention to detail and problem-solving abilities with a high degree of accuracy.

• Proficiency in Microsoft Office applications including Word, Excel, Outlook, OneNote, etc.

• Previous experience using a CRM, preferably Salesforce.

• **Bilingual proficiency in both English and Spanish is mandatory.**

🏝️ Benefits

• Competitive salary

• Comprehensive health, dental, and vision insurance, along with life and disability coverage

• Retirement savings plan with company matching

• Generous vacation and time-off policy

• Opportunities for professional development

• Flexible and remote work environment