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Bilingual Commercial Health Call Center Representative (Spanish)

3 hours, 39 minutes ago
United States
Full-time
Junior
Customer Support
Customer and Technical Support
CRM Salesforce
Apply Now
Evry Health

Evry Health

Evry Health is a modern health insurance company that prioritizes delivering great benefits at affordable prices. They offer a unique approach to health insurance by focusing on making members healthier and happier through personalized care from a dedi...

Insurance
11-50
Founded 2017
$7M raised
View All Jobs 4

Description

  • Research and resolve inbound and outbound member and provider inquiries, meeting quality, turnaround-time, and productivity targets.
  • Explain plan benefits, eligibility, cost sharing, claims decisions, claim status, prior authorization requirements, and payment details.
  • Apply knowledge of CPT, ICD-10, HCPCS, and Revenue Codes when addressing health plan questions.
  • Support pharmacy and wellness vendor inquiries.
  • Document escalated member and provider situations and coordinate resolutions with Claims, Medical Management, and other teams.
  • Record every interaction accurately in the designated CRM system.
  • Identify inquiry and call trends for leadership and assist members with portal navigation to encourage digital self-service.

Requirements

  • High school diploma or equivalent.
  • At least 2 years of customer service experience supporting a commercial fully insured health plan.
  • Working knowledge of commercial health plan benefits, eligibility, and claims processes.
  • Knowledge of CPT, ICD-10, HCPCS, and Revenue Codes.
  • Fluency in both English and Spanish.
  • Proficiency with Microsoft 365.
  • Preferred: Associate’s or bachelor’s degree in business, healthcare, or a related field.
  • Preferred: Experience with Claims, Medical Management, Appeals and Grievances, Salesforce or another CRM, trend reporting, or team lead/quality responsibilities.
  • Must reside and work in the United States within the CST or EST time zones and be available during weekday 9–5 CST business hours.
  • Must maintain a private, secure home workspace with high-speed internet and protect company-sensitive information.

Benefits

  • Competitive salary.
  • Comprehensive health, dental, vision, life, and disability insurance.
  • Retirement savings plan with company match.
  • Generous paid time off and vacation.
  • Professional development opportunities.
  • Flexible, fully remote work environment.

Interested in this position?

Apply directly on the company website

Apply Now

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