Remote-Customer Service Representative (Bilingual in Spanish)
Core
Remote Regional Concierge Navigator providing outreach and support to members, ensuring access to care and navigating health care and benefits.
Role type
Senior IC customer service representative (health plan member services)
Builds
Coordinated care access and member engagement for seniors and chronically ill individuals
Domain
US Health Insurance / Medicare Advantage / Member Services
Deliverable
client delivery
Required skills
ICD-10 and CPT codes knowledge, Medicare Advantage or HMO navigation, authorizations and referrals processing, high-volume inbound customer service, case follow-up and issue resolution, provider appointment scheduling, medical records retrieval, bilingual English/Spanish communication
Preferred skills
Telemarketing and member outreach experience, escalation or resolution unit experience, high-volume inbound customer service in health plan or Medicare
Technologies
None explicitly stated
Responsibilities
Conduct in-market member engagement including Welcome Calls, New Member Onboarding, and JSA Scheduling; Conduct case follow-ups and quality member issue resolution; Educate members on gaps in care and assist with scheduling provider appointments; Resolve incoming calls concerning members' eligibility, benefits, provider information, clinical, and pharmacy needs; Assist with obtaining medical records from healthcare providers; Participate in on-site member engagement activities as needed
Seniority
Entry-level to Mid-level, hands-on IC