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Bilingual Healthcare Call Center Reps

Essential Functions:


Responsible for inbound phone inquiries in Spanish, primarily dealing with either:


Member benefits and eligibility related to the HMO, EPO/PPO, Medicare and Medicaid, CHP and FHP product lines or


Provider benefits, eligibility, PEP and claim status, member pharmacy calls, utilizing prior approval skills (ACP/DME and CCD) and placing outbound calls on a routine basis.


Resolve issues with respect to benefits and eligibility by researching documentation, system information or gaining knowledge from other employees, management or departments. 


Interact with customers, document call specifics and demonstrate quality program behaviors to create an outstanding relationship with each caller.


Work with outside vendors as needed to answer questions or resolve issues.


Respond to member correspondence/email in writing utilizing an existing CSS system letter to effectively respond to members.


Conduct orientation to new members by providing an overview of the member’s plan and pertaining administrative policy.



Skills, Experience and Education requirement:


Fluency in Spanish and English

High School Diploma

Experience with member and provider calls in Healthcare Insurance

Understanding of Medicaid and PCP. Overall knowledge of Medical Claims, Authorizations and Referrals

Domain Skills

SNo Primary Skill Proficiency Level * Rqrd./Dsrd.
1 Claims NA Desired
2 Medicare & Medicaid Claims NA Desired


* Proficiency Legends

Proficiency Level Generic Reference
PL1 The associate has basic awareness and comprehension of the skill and is in the process of acquiring this skill through various channels.
PL2 The associate possesses working knowledge of the skill, and can actively and independently apply this skill in engagements and projects.
PL3 The associate has comprehensive, in-depth and specialized knowledge of the skill. She / he has extensively demonstrated successful application of the skill in engagements or projects.
PL4 The associate can function as a subject matter expert for this skill. The associate is capable of analyzing, evaluating and synthesizing solutions using the skill.

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