Important things YOU should know: 

• Must be fluent in Spanish
• Fully remote opportunity
• Training schedule: 8:00am- 4:30pm CST Monday – Friday
• Work schedule (after training): 9:30am – 6:00pm CST Monday - Friday
• Hours of operation:  7:00am - 10:00pm CST so shift could flex based on business need
• Occasional evenings, weekends and holidays possible during Annual Medicare Open Enrollment: 10/1 - 3/31
• $2.00/hour differential on Mon/Tues
• Exceptional professional growth in a fun rewarding environment
• Experience with Dental or Health insurance a preferred plus!

What will YOU be doing for us?   

Our Customer Service Representatives must have strong problem-solving skills, coupled with the natural ability to provide empathy for the customer – always taking the time to patiently listen and understand their questions to help find a viable solution, while providing them with a memorable customer experience.

What is in it for YOU?

• Career growth in an inclusive culture
• Paid training
• Health benefits
• 401(k)

What will YOU be working on every day?  

• Servicing our Dental and Vision callers with information regarding their eligibility, benefit coverage, authorizations, claims, and assisting them with locating a provider in their area,
• Utilize knowledge of claim adjustments and resubmission processes to determine appropriate resolution to provider requests.
• Provide feedback to Provider Relations staff on high-level claim issues including but not limited to issues with reimbursement schedules or conflicting information to ensure providers receive a prompt resolution.
• Support enrollment activities including but not limited to assigning primary care providers, and updating third party insurance information.
• Act as liaison between our organization and the client’s Member Services staff to resolve issues such as eligibility and filing appeals and grievances.
• Provide updates to providers with questions regarding the status of their credentialing application.
• Recognize provider questions that could be handled through the use of the provider web portal and provide education to these callers on the benefits of utilizing the technology available.
• Ensure all calls are answered according to company and client guidelines.
• Accurately document call information and resolution in our internal systems.
• Apply effective diffusion techniques when necessary to ensure our customers feel heard, valued and supported.
• Properly identify issues that need to be escalated appropriately to the leadership team.

Additional Responsibilities:

• Provide recommendations on system enhancements and process improvements to management.
• Keep our Provider Relations team updated with provider manual discrepancies, change in locations or any other provider related issues.
• Participate in departmental projects when applicable.

What qualifications do YOU need to have to be GOOD candidate?  

Required Level of Education, Licenses, and/or Certificates

• High school diploma or equivalent

Required Level of Experience

• 1+ years of job related customer service experience within industries such as healthcare, call center, banking or retail

Required Knowledge, Skills, and Abilities

• Must be fluent in Spanish
• Basic knowledge of Microsoft Office products including but not limited to Word, Excel, and Outlook
• Ability to work occasional overtime as needed
• Excellent listening and communication skills
• Superior customer service skills including the natural ability to provide empathy
• Strong data entry/typing skills
• Strong navigation skills and the ability to multi-task
• Excellent attention to detail
• Critical thinking skills to quickly analyze and clearly understand a specific request or customer need
• Leverage knowledge and resources to provide the appropriate solutions

What qualifications do YOU need to be a GREAT candidate?

Preferred Level of Experience

• 1+ years of job related customer service experience within the dental, vision or medical industry
• Previous experience working in a virtual environment
• Understanding of dental, vision and/or medical insurance terminology
• Previous call center experience