Bilingual Call Center Customer Service Representative

About the position

The Bilingual Call Center Customer Service Representative at Driscoll Health is responsible for assisting members and providers with healthcare inquiries, concerns, or complaints via telephone. This role emphasizes compassion and innovation, ensuring that callers receive prompt and accurate responses while adhering to regulatory guidelines and HIPAA requirements. The representative will spend a significant portion of their time on the phone, driving resolution of issues on the first call whenever possible and maintaining effective communication with both members and providers.

Responsibilities

• Assist members and providers by responding to telephone inquiries regarding healthcare issues.
• Drive resolution of caller questions/issues on the first call whenever possible.
• Ensure proper documentation of calls and resolution actions.
• Understand and adhere to HIPAA requirements and regulatory guidelines.
• Navigate through complex computer systems to identify the status of issues and provide appropriate responses.
• Review previous call interactions and notes to assist callers effectively.
• Communicate monthly messages to members and providers as needed.
• Establish and maintain effective working relationships with provider office staff.
• Read, comprehend, and verbalize processes and procedures of the organization and health insurance coverage.
• Multi-task by utilizing multiple complex computer applications.
• Identify issues/trends and escalate to Supervisor/Manager when assistance is needed.
• Develop relationships with other departments to provide feedback about root cause issues.
• Intervene with providers on behalf of the customer to assist with appointment scheduling or connections with specialists.
• Assist customers in navigating through the Driscoll Health Plan website and encourage self-sufficiency.
• Own problems through to resolution on behalf of the customer in real time or through follow-up with the member or provider.
• Research complex issues across multiple databases and work with internal departments to resolve customer issues.

Requirements

• Minimum of a high school diploma or equivalent.
• 6 months of experience working in a call center or healthcare-related field.
• Strong customer service skills, including courteous telephone etiquette and professionalism.
• Prior understanding and awareness of call center metrics and goals preferred.
• Prior healthcare experience, particularly with Medicaid Insurance Plans preferred.
• Ability to type a minimum of 35 words per minute.
• Knowledge of managed care processes and health insurance coverage preferred.
• Knowledge of medical terminology preferred.
• Outstanding communication skills and the ability to understand complex situations.
• Analytical skills and the ability to read and interpret data.
• Problem-solving abilities.
• Ability to work independently and as part of a team.
• Proficiency with Microsoft Office applications, particularly Outlook, Word, and MS Teams.

Nice-to-haves

• Prior understanding and awareness of call center metrics and goals.
• Prior healthcare experience, particularly with Medicaid Insurance Plans.
• Knowledge of managed care processes and health insurance coverage.
• Knowledge of medical terminology.

Benefits

• Health insurance