Bilingual Customer Service Representative (April)

Brighton Health Plan Solutions • Chapel Hill, NC

12h • Remote

About The Position

The Customer Service Representative assists members, physicians, hospitals, revenue agencies and other healthcare providers with member benefits, eligibility, claims inquiry, claim reconsiderations and appeals. The Customer Service Representatives must be able to work in various shifts Monday to Friday between the hours of 9AM – 7PM EST with the ability to adjust shifts with notice based on business needs. This is a remote role. This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities and activities may change, or new ones may be assigned at any time with or without notice.

Requirements

• 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 Microsoft Office (Word, Excel, 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

Nice To Haves

• Previous multi-channel experience is a plus

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 when 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED