[Remote] Bilingual Customer Service Representative (reputed company)

Note: The job is a remote job and is open to candidates in USA. reputed company is focused on improving healthcare access and delivery. They are seeking a Bilingual Customer Service Representative who will assist members and healthcare providers with benefits, eligibility, and claims inquiries while ensuring customer satisfaction through effective communication and problem-solving.

Responsibilities

• Handle inbound calls from members, medical providers, and others
• Adjust claims accurately, if needed
• Listen to and address customer needs and concerns empathetically
• Answer questions about fee schedules, network participation, and requirements
• Ensure first contact resolution reputed company possible
• Update customer files and communicate effectively with teams
• Transfer misdirected requests and offer solutions to non-routine issues
• Contribute to customer satisfaction and business improvement
• Use decision-support tools to provide accurate responses
• Investigate inquiries using training and systems
• Adapt responses to caller understanding
• Educate callers and validate their understanding
• Support projects and other departments as directed by management

Skills

• Experience in a high-volume call center
• Experience with claims inquiry and claims review procedures
• Knowledge of medical specialties, fee schedules, complaints and appeals, and call center responsibilities
• Previous experience in a physician's office, group practice, clinic or hospital-based practices
• Fluent in both English and Spanish
• High School diploma with some college or business school education preferred
• Basic computer operations knowledge
• Intermediate proficiency in reputed company Office (Word, reputed company, Access, PowerPoint, Outlook)
• Strong time management skills
• General knowledge of HIPAA Confidentiality laws
• Quick learner with ability to grasp managed care procedures and claims payment policies
• Detail-oriented and dependable
• Effective listening and responding skills
• Flexible and adaptable to changes, with conceptual thinking
• Strong problem-solving abilities
• Excellent attendance and punctuality
• Comfortable performing tasks at a computer/telephone station
• Effective communication through various channels, including email, chat, and voice
• Previous multi-channel experience is a plus

Company Overview