Bilingual Spanish Resolution Specialist

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

📋 Description

• Address and resolve member issues related to healthcare insurance claims.

• Handle complex member cases and ensure timely and satisfactory resolutions.

• Act as a subject matter expert for escalated member inquiries regarding authorizations, claims, and provider network matters.

• Recognize opportunities for process improvement within the member engagement department.

• Clarify procedures, protocols, benefits, and services to address member inquiries and issues.

• Make outbound calls and receive inbound calls in accordance with departmental timelines.

• Manage member communication preferences, which include time of day, channel, and language.

• Collaborate with other departments, supplemental benefit vendors, and provider network partners.

• Identify members with care gaps and campaigns, assess program eligibility, and connect members with suitable programs, providers, or vendors.

• Accurately document member information in systems and applications, completing wrap-up activities in a timely manner.

• Submit activity reports and achieve both individual and team objectives.

• Engage in mandatory team meetings and training sessions.

• Comply with attendance and productivity standards.

• Assist in the development and training of new hires through shadowing and nesting.

⛳️ Requirements

• At least one year of healthcare experience and/or training is required; three to four years of healthcare experience/training is preferred.

• Minimum of one year of outbound call center experience and/or inbound call center experience involving escalation or resolution.

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

• Experience guiding members through Medicare Advantage benefits, including medical, prescription drug, and supplemental benefits.

• High school diploma or GED; or an equivalent combination of education and experience.

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

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

• Ability to work full-time and potentially overtime during the Annual Enrollment Period and Open Enrollment Period.

• Capable of troubleshooting, problem-solving, interpreting documents, writing routine reports and correspondence, and effectively speaking before groups.

• Proficient in basic arithmetic using American currency and measurement units.

• Ability to follow detailed written or oral instructions and resolve problems involving standardized situations.

• Independent, motivated self-starter with the ability to prioritize work assignments.

• Team-oriented and eager to assist colleagues.

• Strong passion for customer service and member retention.

• Comfortable engaging in phone conversations.

🏝️ Benefits

• Full-time employment.

• Overtime opportunities during the Annual Enrollment Period and Open Enrollment Period.

• Opportunities for growth and innovation.

• Equal Opportunity/Affirmative Action employment.