Customer Service Representative - Bilingual

Job Type: Full-time

About the role

The Bilingual Customer Service Representative promotes favorable interaction with patients, providers, and payers through prompt, accurate, and courteous resolution of telephone and written inquiries. This position primarily handles inbound calls relating to medical, pharmacy, vision, and related healthcare options.

Responsibilities

• Assist with questions, complaints, and concerns as well as explanation of policies and procedures in English and Spanish.
• Receive inbound calls from patients, providers, and members; occasionally return calls.
• Apply a variety of concepts, best practices, and follow policy and procedures.
• Provide responses in English and Spanish to inquiries and complaints for all phases of operations including billing claims, denials, payments, and others.
• Explain account situations to ensure member understanding.
• Respond promptly to written inquiries or provide callbacks from messages in English and Spanish.
• Aim to resolve inquiries on the first call by being proactive and demonstrating product knowledge.
• Meet or exceed performance metrics including quality, accuracy, call handling time, and member satisfaction; standards may be revised.
• Escalate advanced issues as appropriate.

Requirements

• High School Diploma or equivalent.
• 1 year of customer service experience in a medical/healthcare setting, including knowledge of medical terminology, how to read and explain a claim or EOB, and working in a production environment speaking, writing, and reading English and Spanish.
• Solid working knowledge of standard computer applications including MS Word, Excel, Outlook, and PowerPoint.
• Ability to use a computer, including expert keyboard and navigation skills and learning new programs.
• Communicate clearly and professionally with internal and external customers.
• Work effectively as part of a team to achieve established outcomes.
• Understand others’ roles and empower one another to take responsibility for success.
• Demonstrate collaborative interaction with peers to reach common goals and be a resource to team members and internal/external customers.
• Pay close attention to detail in all aspects of the job.
• Make decisions using available resources and sound judgment.
• Maintain confidentiality and discretion.
• Identify and resolve problems in a timely manner; gather and analyze information skillfully.
• Share knowledge with associates by effectively communicating and providing follow-up.
• Open to others’ ideas and exhibits a willingness to try new things.
• Demonstrate accuracy and thoroughness; monitor work to ensure quality.
• Prioritize and plan work activities to use time efficiently.
• Adapt to changes in the work environment, manage competing demands, and handle frequent change, delays, or unexpected events.
• Follow instructions, respond to direction, and solicit feedback to improve.
• Act in a way that instills trust from management, other associates, and customers.
• Work overtime as required.

Physical and Cognitive Demands

• Constant: Talk, hear, speak, and use hands and fingers to operate a computer, telephone, keyboard/mouse; occasionally move about the office.
• Constant: Visual ability such as close vision, distance vision, color and peripheral vision, depth perception, and ability to adjust focus.
• Occasional: Lift and/or move up to 30-50 pounds.
• Constant: Regular, predictable attendance in the office is required.
• Constant: While performing the duties of this job, the employee is regularly sitting for the full shift.
• The cognitive skills needed to complete tasks include abilities such as learning, remembering, focusing, categorizing, and integrating information for decision-making, problem-solving, and comprehending.

Work Environment

The work environment is indoors in a controlled climate, office setting. The noise level may be low to moderate. The duties described are representative but not restrictive of tasks that may be assigned or abilities required to do the job. The description is subject to change at any time.

Pay

$24–$26 per hour