Spanish Bilingual Healthcare Call Center Representative

This job was posted by : For more information, please see: As a Spanish Bilingual Healthcare Call Center Representative, you will be the cornerstone of our commitment to customer satisfaction. In this role, you will provide comprehensive support and information to members, providers, and patients, ensuring they maximize the benefits of their healthcare plans and services. By adhering to compliance guidelines and embodying our company values, you will deliver extraordinary service while building trust and rapport with current and prospective members. What You'll Be Doing: Customer Interactions:\ Manage inquiries in areas such as Member Services, Medicare, and Billing , assisting Spanish- and English-speaking customers.\ Represent our client professionally by addressing and documenting all incoming queries, including complex calls related to specialized product lines. Quality Service:\ Uphold the organization's philosophy of extraordinary customer relations.\ Proactively engage with Health Plan, medical group, and facility personnel to gather relevant information for resolving member inquiries. Problem Resolution:\ Analyze and evaluate customer issues to initiate and coordinate service recovery measures.\ Document all member interactions meticulously following established procedures. Healthcare Knowledge\ Demonstrate familiarity with health insurance terminology (copays, deductibles, claims, authorizations, etc.).\ Understand Medicare/Medicaid plans and regulations, and explain plan benefits, provider networks, and coverage policies. Operational Excellence\ Leverage a thorough understanding of company policies and processes to meet customer needs effectively.\ Contribute to departmental goals and objectives while maintaining proficiency through ongoing training and use of required tools. Performance Metrics:\ Monitor and achieve Contact Center KPIs, including call handling, first call resolution, and member retention. Compliance and Ethics:\ Consistently uphold company compliance standards and Code of Conduct, ensuring privacy and confidentiality of member information.\ Adhere to HIPAA regulations to protect personal health information (PHI) and maintain data security.