Bilingual Call Center Representative (Healthcare) - Tallahassee, FL - Hybrid
About The Position
As a Bilingual Call Center Representative (Healthcare) - Tallahassee, FL - Hybrid at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position.Your role in our mission Answers telephones and responds to basic customer questions and/or forwards to appropriate personnel and provides consultancy utilizing knowledge and expertise on insurance and healthcare. Develops and implements general insurance and health care policies in accordance with state and federal laws and provides expertise to investigate and adjudicate claim characteristics that do not match policy provisions. Responds to provider appeals and meets with providers to resolve problems/issues. Advises provider review councils, state officials and works with organized healthcare groups and associations on various medical issues related to insurance and healthcare programs. Processes calls in a manner that ensures service level agreements (SLAs) are met or exceeded. Records calls, processes requests and updates account history with results of inquiry to include proper documentation. Interfaces with team members, management, and customers in reference to customer service issues. Review and recommends modification to procedures and workflow as necessary to ensure efficient and effective processing of transactions.
Requirements
- Bilingual proficiency in English and Spanish is required
- 2 or more years of customer service experience in any industry
- Knowledge of basic help desk software, computer software and Microsoft Office applications
- Strong problem-solving skills to bring inquiries to effective resolution
- Strong customer service skills with an emphasis on written and oral communication to respond to inquiries professionally
- Ability to understand your role on a team and identify the correct stakeholders to consult to resolve client inquiries
Responsibilities
- Answers telephones and responds to basic customer questions and/or forwards to appropriate personnel and provides consultancy utilizing knowledge and expertise on insurance and healthcare.
- Develops and implements general insurance and health care policies in accordance with state and federal laws and provides expertise to investigate and adjudicate claim characteristics that do not match policy provisions.
- Responds to provider appeals and meets with providers to resolve problems/issues.
- Advises provider review councils, state officials and works with organized healthcare groups and associations on various medical issues related to insurance and healthcare programs.
- Processes calls in a manner that ensures service level agreements (SLAs) are met or exceeded.
- Records calls, processes requests and updates account history with results of inquiry to include proper documentation.
- Interfaces with team members, management, and customers in reference to customer service issues.
- Review and recommends modification to procedures and workflow as necessary to ensure efficient and effective processing of transactions.
Benefits
- Most benefits start on first day of employment
- All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance.
- We also have a variety of leadership and technical development academies to help build your skills and capabilities.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
Number of Employees
5,001-10,000 employees
