CCO Service Agent, Bilingual

This is a fully remote position, open to applicants in Florida, +1 more state.

📋 Description

• Delivers outstanding customer service to our members and/or providers regarding all aspects of inquiries and issues related to eligibility, benefits, claims processes, escalations, and product queries, among others.

• Achieves or surpasses all performance KPIs, including but not limited to quality, productivity, and reliability.

• Adheres to established policies and procedures to ensure that member and provider concerns are resolved promptly and accurately.

• Recognizes and de-escalates situations where members/providers are dissatisfied, providing effective resolutions to their issues.

• Initiates investigations as necessary, collaborating with other assigned parties to engage in root cause analysis, taking proactive and/or corrective actions, and recommending solutions and methods for process enhancement while following up on unresolved customer inquiries and complaints within a specified timeframe.

• Complies with HIPAA regulations and safeguards the confidentiality of Protected Health Information (PHI) pertaining to members, providers, medical, and departmental data, while adhering to local, state, federal, and company-specific compliance and regulatory standards.

• Fosters sustainable relationships of trust through open and interactive communication with both internal and external customers.

• Works a flexible schedule that may include late shifts, weekends, and/or holidays (sometimes with limited notice), and as required during unforeseen business interruptions.

• Performs additional duties as necessary.

⛳️ Requirements

• High School Diploma or GED from an accredited institution.

• Previous experience in a customer service setting.

• Experience in participating in cross-functional projects and departmental initiatives related to customer/client engagement and customer service.

• Practical experience in a fast-paced work environment.

• Proficient in Microsoft Office Suite, including Excel, Word, and Outlook.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Incentive and recognition programs.

• Life insurance.

• 401k contributions.