Customer Service Representative - Bilingual

Job Summary:

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

Duties and 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 call backs from messages in English and Spanish.
• Aim to resolve inquires 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.