Bilingual Spanish Resolution Specialist

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

📋 Description

• Act as a "subject matter expert" for escalated member calls concerning authorizations, claims, and provider network issues, resolving these escalations based on your knowledge and experience with healthcare processes and protocols.

• Recognize opportunities for process improvements within the member engagement department through collaboration with various departments.

• Possess comprehensive knowledge of procedures, protocols, benefits, services, and other essential information to address member issues and inquiries effectively.

• Make outbound calls and/or receive inbound calls within the department's target timeframe; successfully engage with members according to their communication preferences, which may include preferred times, channels, and languages; leverage multilingual skills or interpreter services as necessary.

• Work collaboratively with partners, including other departments, supplemental benefit vendors, and the provider network, to enhance the member experience.

• Identify members who are targeted for care gaps and various campaigns, connecting them to appropriate programs or services; assess available programs, confirm eligibility, and link members to the suitable provider or vendor.

• Document interactions in real-time and perform timely wrap-ups to assist with outcomes reporting in all systems/applications by accurately entering member demographics and information while maintaining attention to detail and data integrity to support quality organizational data.

• Achieve and surpass individual and team targets by submitting activity reports in the required format and frequency.

• Deliver outstanding customer service and foster a culture of exceeding expectations to ensure the highest level of member satisfaction.

• Take part in all mandatory team meetings and training sessions, demonstrating a satisfactory understanding of new information and processes.

• Comply with all relevant attendance and productivity policies.

• Support the development and training of new hires through shadowing and nesting activities.

⛳️ Requirements

• A minimum of one (1) year of healthcare experience and/or training is required; three to four years of healthcare experience/training is preferred.

• At least one (1) year of outbound call center experience, which may encompass welcome/onboarding, appointment scheduling, retention, sales, or other healthcare/health plan-related programs; and/or inbound call center experience demonstrating a higher level of problem-solving abilities, such as escalation or resolution.

• Experience assisting members in navigating access to care through Medicare Advantage or HMO, including referrals and authorizations.

• Familiarity with helping members understand their Medicare Advantage benefits, including medical, prescription drug, and supplemental benefits.

• High school diploma or general education degree (GED); or an equivalent combination of education and experience.

• Intermediate proficiency in Microsoft Office Suite (Outlook, Word, Excel) is required.

• Bilingual skills in English and Spanish, Chinese (Mandarin or Cantonese), or Vietnamese are preferred.

• A self-motivated, independent individual who can prioritize tasks and ensure that each day is productive.

• A team player willing to assist and support colleagues.

🏝️ Benefits

• Health insurance

• 401(k) matching

• Flexible work hours