Bilingual Customer Service Representative

Seeking a bilingual (Spanish/English) customer service specialist.

JOB SUMMARY:

The Customer Service Representative position interacts with customers to provide and process information in response to general inquiries, concerns, and requests about products and services across multiple lines of business. The CSR must project a professional company image and provide superior customer service by corresponding with customers via any of the customer contact channels.

PRIMARY JOB RESPONSIBILITIES:

• Assist providers by resolving coordination of benefits inquiries by analyzing patient activity (including enrollment, third-party liability, and claims attachments).
• Interpret and communicate accurate insurance coverage by having a comprehensive understanding of the process.
• Thoroughly and completely document all customer interactions.
• Educates customers and dental professionals on eligibility, benefits, claims payment, and authorizations.
• Provides direction on the usage and benefits of self-service tools.
• Assist members on gaining access to care by locating a network dentist or assignment to a primary care dentist.
• Appropriately routes inquiries to the necessary departments or individuals when resolution of the inquiry is beyond the span of control of this role.
• Responds to customer inquiries in a courteous and professional manner.
• Researches assistance requested and consistently provides accurate information to resolve internal and external member and provider inquiries via verbal and written communications through all channels including phone, email, web portal, and chat interactions.
• Responds to and resolves internal and external complex customer inquiries via verbal and written communications through all channels including phone, email, web portal, and chat interactions.
• Resolves claim payment inquiries by researching and analyzing patient activity and determines appropriate action to be taken.
• Takes ownership of the resolution and sets expectations for follow up.
• Ensures resubmissions, stop payments, and voids are handled appropriately.
• Meets or exceeds individual, department, and client specific goals.
• Understands and adheres to all administrative and contractual policies and procedures.
• Contributes to the success of the organization by suggesting ways to improve the service delivery processes.
• Other duties as assigned.

JOB REQUIREMENTS:

• High School Diploma or Equivalent.
• 2-years of experience in a high-volume customer service environment.
• 1-year experience in health insurance industry.
• Experience utilizing multiple software applications simultaneously.
• Ability to set-up computer equipment and troubleshoot issues with minimal assistance.
• Proven professional verbal and written communication skills.
• Ability to efficiently operate a computer and knowledge of Microsoft Office applications.
• Strong organizational skills and attention to detail.
• Ability to work independently and with a team.
• Ability to learn quickly and adapt to a fast pace production environment.
• Cooperative, professional and effective interaction skills with co-workers, company staff and visitors.
• Critical thinking and problem-solving skills.
• Ability to tolerate repetitive work without compromising accuracy and service levels.
• Required to attend additional training as requested/deemed necessary.

Preferred:

• Medical/Dental terminology knowledge experience.
• Medicare/Medicaid knowledge.
• Claims/Billing and coding experience.
• Experience with Cisco phone system a plus.

PHYSICAL DEMANDS:

• Incumbent must be able to communicate effectively.
• Requires overall light physical effort (up to 25lbs.)
• Manual dexterity and sitting is required in carrying out position own position responsibilities (i.e. use of personal computer).
• Ability to travel or move about within and outside serviced facilities required.
• The incumbent works primarily in either a private or shared office environment. The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform this position.