** Bi-lingual Healthcare Customer Service Representative**

Date: Jan 7, 2022 Location: Tallahassee, FL, US, 32301-5020

Req ID: 8139 **Summary**

**Job Description**

Job Description:

Answers telephones and responds to basic customer questions and/or forwards call to appropriate personnel.

Provides consultancy utilizing knowledge and expertise on insurance and healthcare.

Develops and implements general insurance and health care policies in accordance with state and federal laws.

Provides expertise to investigate and adjudicate claim characteristics that do not match policy provisions.

Responds to provider appeals and meets with providers to resolve problems/issues.

Provides directions for utilization review.

Records call on account history record with results of the inquiry; initiates required confirmation without direct supervision. Researches customer inquiries and responds to appropriate parties in a timely manner.

Processes customer requests by sending emails, or using other related communication.

Processes calls in a manner that ensures service level agreements (SLAs) are met or exceeded. Records calls, processes requests and updates account history with results of inquiry to include proper documentation.

Advises provider review councils, state officials and works with organized healthcare groups and associations on various medical issues relate to insurance and healthcare programs.

Interfaces with team members, management, and customers in reference to customer service issues.

Reviews and recommends modification to procedures and workflow as necessary to ensure efficient and effective processing of transactions.

Ability to speak Spanish and English.

**Basic Qualifications**

* High school diploma or G.E.D.

* Two or more years of customer service or other telephone experience

* Experience working with organizational functions and personnel

* Experience working with fax machines, computer software, and telephone technology

* Experience working with and skilled in the use of help desk software

**Other Qualifications**

* Business and analytical problem solving skills

* Communication skills

* Ability to work independently

* Ability to follow oral and written directions

**Work Environment**

* Office environment

* May require shift work

**Job Description**

**Qualifications**