Description

Answers telephones and responds to basic customer questions and/or forwards call to appropriate personnel.
Provides consultancy utilizing knowledge and expertise on insurance and healthcare.
Develops and implements general insurance and health care policies in accordance with state and federal laws.
Provides expertise to investigate and adjudicate claim characteristics that do not match policy provisions.
Responds to provider appeals and meets with providers to resolve problems/issues.
Provides directions for utilization review.
Records call on account history record with results of the inquiry; initiates required confirmation without direct supervision. Researches customer inquiries and responds to appropriate parties in a timely manner.
Processes customer requests by sending emails, or using other related communication.
Processes calls in a manner that ensures service level agreements (SLAs) are met or exceeded. Records calls, processes requests and updates account history with results of inquiry to include proper documentation.
Advises provider review councils, state officials and works with organized healthcare groups and associations on various medical issues relate to insurance and healthcare programs.
Interfaces with team members, management, and customers in reference to customer service issues.
Reviews and recommends modification to procedures and workflow as necessary to ensure efficient and effective processing of transactions.
Speak and Understand English and Spanish fluently

Responsibilities

High school diploma or G.E.D.
Two or more years of customer service or other telephone experience
Experience working with organizational functions and personnel
Experience working with fax machines, computer software, and telephone technology
Experience working with and skilled in the use of help desk software
Business and analytical problem solving skills
Communication skills
Ability to work independently
Ability to follow oral and written directions

Hard Skills

Multi-line phone proficiency
Customer relations
Customer success
Advanced language knowledge
Advanced writing skills

Soft Skills

Gainwell Technologies

View profile

Main info
Language English, Spanish
Experience level Entry Level
Job type Full Time
Salary negotiable
CountryUnited States of America

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We offer

Office environment
May require shift work

Bilingual Customer Service Representative - Healthcare

Description

Answers telephones and responds to basic customer questions and/or forwards call to appropriate personnel.

Provides consultancy utilizing knowledge and expertise on insurance and healthcare.

Develops and implements general insurance and health care policies in accordance with state and federal laws.

Provides expertise to investigate and adjudicate claim characteristics that do not match policy provisions.

Responds to provider appeals and meets with providers to resolve problems/issues.

Provides directions for utilization review.

Records call on account history record with results of the inquiry; initiates required confirmation without direct supervision. Researches customer inquiries and responds to appropriate parties in a timely manner.

Processes customer requests by sending emails, or using other related communication.

Processes calls in a manner that ensures service level agreements (SLAs) are met or exceeded. Records calls, processes requests and updates account history with results of inquiry to include proper documentation.

Advises provider review councils, state officials and works with organized healthcare groups and associations on various medical issues relate to insurance and healthcare programs.

Interfaces with team members, management, and customers in reference to customer service issues.

Reviews and recommends modification to procedures and workflow as necessary to ensure efficient and effective processing of transactions.

Speak and Understand English and Spanish fluently

Responsibilities

High school diploma or G.E.D.

Two or more years of customer service or other telephone experience

Experience working with organizational functions and personnel

Experience working with fax machines, computer software, and telephone technology

Experience working with and skilled in the use of help desk software

Business and analytical problem solving skills

Communication skills

Ability to work independently

Ability to follow oral and written directions

Hard Skills

Soft Skills

We offer

Office environment

May require shift work