Bilingual Customer Service Representative II
About the Company: Well established Healthcare company committed to improving community health is seeking professional Bilingual Customer Service Representatives to join their team.
Type: Contract-to- Hire
Schedule: Monday – Friday, must be able to work 8hr shift between 8am-8pm
In this role, you will be responding to customer inquiries via telephone and written correspondence in a timely and appropriate manner.
- Respond to telephone or written correspondence inquiries from members and/or providers within established time frames utilizing current reference materials and available resources
- Reference current materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits and authorization status matters
- Provide assistance to members and/or providers regarding website registration and navigation
- Document all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application
- Educate members and/or providers on health plan initiatives Provide first call resolution working with appropriate internal/external resources, and ensure closure of all inquiries
- Process written customer correspondence and provide the appropriate level of timely follow up
- May coordinate member transportation and make referrals to other departments as appropriate
- Maintain performance and quality standards based on established call center metrics including turn-around times
- Research and identify any processing inaccuracies in claim payments and route to the appropriate site operations team for claim adjustment
- Identify trends related to member and/or provider inquiries that may lead to policy or process improvements that support excellent customer service and impact quality and performance standards
- Work with other departments on cross functional tasks and projects
You are the right candidate for this role if you meet the following requirements:
- Bi-lingual – Read, Write and Speak Fluent Spanish and English
- Education: High school diploma or equivalent or Associates degree and claims processing, billing and/or coding experience preferred.
- 1+ years of experience in Medicare, Medicaid managed care or insurance environment preferred.
- 2+ years of customer service experience in a call center environment.
- Knowledge of managed care programs and services preferred.