Remote-Bilingual Spanish Resolution Specialist

Overview Of The Role

The Remote Resolution Specialist provides member issue resolution managing and resolving healthcare insurance claims in a timely and accurate manner. This role requires solid analytical skills, knowledge of healthcare insurance policies, and a commitment to providing exceptional service to policyholders, healthcare providers, and internal stakeholders.

Responsibilities

• Serve as a “subject matter expert” in escalated member calls (authorizations, claims, provider network issues) and be able to resolve these escalations based on level of understanding / experience of healthcare processes and protocols.
• Identify process improvement opportunities within the member engagement department given the collaboration with different departments.
• Knowable in procedures, protocols, benefits, services, and any other necessary information to resolve member issues and inquiries.
• Conduct outbound phone calls and / or receive inbound phone calls within the department’s goal timeframe; successfully contact and manage to the member’s communication preferences as possible, which may include time of day, channel, and language; multi-lingual skills and / or utilize interpreter service as needed.
• Collaborate with our partners, including other departments, supplemental benefit vendors, and provider network, to facilitate the member experience.
• Identify members targeted for care gaps and other campaigns and connect members to programs or services when appropriate; analyze available programs, determine program eligibility, and connect member to appropriate provider or vendor.
• Document real-time and conduct timely wrap-up to support outcomes reporting in all systems / applications by entering member demographics and information with accuracy and pay attention to detail, focusing on data integrity in support of quality organizational data.
• Meet and exceed individual and team goals by submitting activity reports in the format and frequency required.
• Provide excellent customer service and contribute to a culture of going “above and beyond” to ensure the highest level of member satisfaction.
• Participate in all required team meetings and trainings and demonstrate satisfactory understanding of new information and process.
• Adhere to all applicable attendance and productivity policies.
• Assist with development and training of new hires including shadowing and nesting.

Required Skills and Experience

• Minimum (1) year healthcare experience and / or training required; 3-4 years of healthcare experience / training required.
• Minimum (1) year outbound call center experience which may include welcome / onboarding, appointment scheduling, retention, sales, or other health care / health plan related programs; and / or inbound call center experience that indicates a higher level of problem-solving such as escalation or resolution.
• Experience helping members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations.
• Experience helping members navigate their Medicare Advantage benefits including medical, prescription drug, and supplemental benefits.
• High school diploma or general education degree (GED); or equivalent combination of education and experience.
• Intermediate proficiency in Microsoft Office Suite (Outlook, Word, Excel) required.
• Bilingual English and Spanish, Chinese (Mandarin or Cantonese), or Vietnamese.
• Independent, motivated, self-starter who can prioritize work assignments and make every day a productive day.
• Team player willing to help and support colleagues and do their part to support us all reaching our organizational goals.
• Passionate about customer service and member retention.
• Excellent customer service and comfortable being on the phone.
• Able to troubleshoot and problem solve.
• Able to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
• Able to write routine reports and correspondence.
• Able to speak effectively before groups of customers or employees of the organization.
• Able to add and subtract two-digit numbers and to multiply and divide with 10’s and 100’s. Able to perform these operations using units of American money and weight measurement, volume, and distance.
• Able to apply common sense understanding to carry out detailed, but un-involved written or oral instructions.
• Able to deal with problems involving a few concrete variables in standardized situations.

Work Environment

Must be available annually to work full-time and over-time through the Annual Enrollment Period (October through December) and Open Enrollment Period (January through March).

Pay Range

$41,600.00 - $57,600.00 Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.