Bilingual Customer Service Representative
About The Position
Responsibilities include answering incoming calls related to eligibility, benefits, claims, and authorization of services from members or providers. - Respond accurately to inbound calls and process inquiries from providers and members. - Resolve customer service or billing issues under general supervision, using sound judgment. - Contact customers to address complex inquiries or inform them of claim investigation outcomes. - Refer unresolved grievances, appeals, and claim resolutions to appropriate departments. - Maintain records of customer interactions and transactions. - Listen actively and probe callers to understand the purpose of their calls. - Research and communicate information regarding member eligibility and claim status. - Educate providers on claim submission processes and treatment plan requirements. - Perform follow-up tasks to ensure member or provider needs are fully met.
Requirements
- High School Diploma
- Strong computer, technical, and data entry skills
- Experience with computer applications, such as Microsoft Word and PowerPoint.
- Previous customer service/call center experience is required.
Responsibilities
- Answering incoming calls related to eligibility, benefits, claims, and authorization of services from members or providers.
- Respond accurately to inbound calls and process inquiries from providers and members.
- Resolve customer service or billing issues under general supervision, using sound judgment.
- Contact customers to address complex inquiries or inform them of claim investigation outcomes.
- Refer unresolved grievances, appeals, and claim resolutions to appropriate departments.
- Maintain records of customer interactions and transactions.
- Listen actively and probe callers to understand the purpose of their calls.
- Research and communicate information regarding member eligibility and claim status.
- Educate providers on claim submission processes and treatment plan requirements.
- Perform follow-up tasks to ensure member or provider needs are fully met.
Benefits
- Medical, dental & vision
- Critical Illness, Accident, and Hospital
- 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
- Life Insurance (Voluntary Life & AD&D for the employee and dependents)
- Short and long-term disability
- Health Spending Account (HSA)
- Transportation benefits
- Employee Assistance Program
- Time Off/Leave (PTO, Vacation or Sick Leave)
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What This Job Offers
Career Level
Mid Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
