Bi-lingual Spanish Client Concierge Specialist

Duties And Responsibilities

• Serve as the primary point of contact for inbound calls, emails, and digital inquiries from members and providers in English and Spanish
• Deliver personalized, concierge-level service by understanding member needs and providing tailored solutions which include outbound contacts
• Aid members with benefits education, eligibility verification, and plan navigation
• Guide members through claims inquiries, including status, processing, and explanation of benefits (EOBs) ensuring delivery in an understandable, polite manner
• Support provider searches, appointment coordination, and healthcare navigation
• Research and resolve complex issues related to claims, billing, and coverage
• Investigate and resolve disputes/escalations. This involves research and identifying root causes of denials/underpayments and other errors and gathering what is needed to resolve the issues
• Identify the reason for the escalation and provide research until resolution is reached
• Update and maintain accurate records of progress, action taken, pending items and status; communicate updates to internal and external stakeholders
• Escalate unresolved or high-impact issue appropriately
• Meet or exceed performance metrics including quality, accuracy, call handling time, time to resolution, work volume and member satisfaction
• Deliver empathetic, professional communication and support retention by creating positive and seamless interactions

Requirements

• High school graduate or equivalent
• Associates or Bachelor level degree preferred
• 2+ years of experience in a customer service or call center environment handling escalation/2nd tier inquires in a healthcare, insurance or TPA environment
• Speaking, writing and reading English and Spanish
• Comfortable supporting multiple channels and adjusting to dynamic workloads
• Familiarity with call center metrics and quality standards
• Experience with claims processing, benefits, eligibility systems preferred
• Experience with CRM systems or customer support platforms preferred
• Experience in working escalations through emails and spreadsheets meeting timely resolution
• Previous exposure to workforce management or scheduling tools
• Solid working knowledge of standard computer applications including MS Word, Excel, Outlook, and PowerPoint
• Ability using a computer which includes expert keyboard and navigation skills and learning new programs
• Communicate clearly and professionally with internal and external customers
• Work effectively individually and as part of a team to achieve established outcomes
• Understand other’s roles and empower one another to take responsibility to be successful
• Communicate knowledge to associates by effectively communicating and providing follow-up
• Exhibit a willingness to try new things
• Identify and resolve problems in a timely manner, gather and analyze information skillfully and proactively
• Share knowledge with associates by effectively communicating and providing follow-up
• Prioritize and plan work activities to use time efficiently
• Adapt to changes in the work environment, manage competing demands and is able to deal with frequent changes, delays, or unexpected events
• Follows instructions, responds to direction, and solicits feedback to improve
• Act in such a way to instill trust from management, other associates, as well as customers
• Work overtime as required