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About the Role

As a Spanish Bilingual Healthcare Call Center Representative, you will be the cornerstone of our commitment to customer satisfaction. In this role, you will provide comprehensive support and information to members, providers, and patients, ensuring they maximize the benefits of their healthcare plans and services. By adhering to compliance guidelines and embodying our company values, you will deliver extraordinary service while building trust and rapport with current and prospective members.

Responsibilities

• Manage inquiries in areas such as Member Services, Medicare, and Billing, assisting Spanish- and English-speaking customers.
• Represent our client professionally by addressing and documenting all incoming queries, including complex calls related to specialized product lines.
• Uphold the organization’s philosophy of extraordinary customer relations.
• Proactively engage with Health Plan, medical group, and facility personnel to gather relevant information for resolving member inquiries.
• Analyze and evaluate customer issues to initiate and coordinate service recovery measures.
• Document all member interactions meticulously following established procedures.
• Demonstrate familiarity with health insurance terminology (copays, deductibles, claims, authorizations, etc.).
• Understand Medicare/Medicaid plans and regulations, and explain plan benefits, provider networks, and coverage policies.
• Leverage a thorough understanding of company policies and processes to meet customer needs effectively.
• Contribute to departmental goals and objectives while maintaining proficiency through ongoing training and use of required tools.
• Monitor and achieve Contact Center KPIs, including call handling, first call resolution, and member retention.
• Consistently uphold company compliance standards and Code of Conduct, ensuring privacy and confidentiality of member information.
• Adhere to HIPAA regulations to protect personal health information (PHI) and maintain data security.
• Use multiple systems/screens while assisting callers effectively.
• Navigate CRM, EMR/EHR, and ticketing platforms effectively.

Requirements

• Fluency in both Spanish and English (spoken and written) is required.
• Minimum of two (2) years of customer service or healthcare member-interaction experience.
• Previous call center experience and/or prior experience in the health insurance industry (preferred).
• High School Diploma or GED required.
• Outstanding written and verbal communication skills.
• Proven analytical and problem-solving abilities.
• Ability to respond concisely and clearly to customer queries.
• Strong critical thinking and problem-solving skills.
• Typing speed of at least 35 WPM with a 5% or lower error rate.
• A dedicated, quiet workspace with a door that closes, free from ambient noise.
• A comfortable desk and chair setup that allows for the proper installation of necessary equipment.
• Stable, high-speed internet with a minimum bandwidth of 20 Mbps downstream and 20 Mbps upstream.
• Comfort with technology and ability to learn new systems quickly.
• Ability to stay productive and manage your time effectively in a remote environment.
• Strong verbal and written communication skills, especially in a virtual setting.
• Ability to adapt to changing technologies and procedures while working remotely.

Skills

• Spanish
• English
• Customer Service
• Healthcare Navigation
• Compliance Adherence
• Problem-Solving
• Communication
• Critical Thinking
• Typing (35 WPM, <5% error rate)
• Technology Proficiency
• Time Management
• Adaptability

Location

• Remote (Virtual Environment)

Work Type

• Remote
• Full-time

Experience Level

• 2+ years customer service or healthcare member-interaction experience

Education Level

• High School Diploma or GED

Salary/Compensations

• up to USD 16.50 - hourly

Benefits

• Full health insurance coverage, including medical, dental, and vision plans.
• Cell Phone Benefits: $25/month per line for unlimited phone, text, and data (restrictions may apply).
• Opportunities for performance-based increases.
• Abundant advancement opportunities within the organization.

About the Company

• Trusted Leader in Healthcare Services
• We're committed to bringing passion and customer focus to the business.
• If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!

Equal Opportunity

• We are an Equal Opportunity Employer, welcoming individuals with disabilities and veterans.