Job Description
Note: The job is a remote job and is open to candidates in USA. Pinnacle Claims Management is an innovative third-party administrator that provides comprehensive health benefits administration services. The Bilingual Operations Specialist I will assist Child Care Providers and Agents with telephonic and web-based support, focusing on eligibility management and troubleshooting application issues.
Responsibilities
- Foster and build good working relationships with Providers, Agents, Certified Enrollment Counselors, and federal and state agency contacts
- Respond to customer questions telephonically or in writing regarding insurance benefits, provider contracts, eligibility, and claims confidentially, professionally, and ethically
- Research and resolve aged customer service open calls within company standards
- Obtain and extract information from the Health Care Processing System (HCPS) and other systems
- Develop and maintains positive customer relations and coordinate with various departments to ensure customer requests and questions are handled appropriately and promptly
- Be accountable and resolve issues by measuring impact, improving, and correcting course
- Adhere to the call center’s quality assurance guidelines to ensure best-in-class service is provided during all interactions
- Thoroughly document information, activities, inquiry outcomes, and changes in the database for accurate tracking and analysis
- Research and analyze data to address operational challenges and customer service issues
- Provide external and internal customers with the requested information
- Communicate with the appropriate departments and identifies service issues
- Identify inefficiencies within the established processes and suggest possible solutions to save time, reduce risk, and reduce expenses
- Meet and maintain all KPIs to support the department service metrics and performance objections
- Maintain regular attendance per employee handbook guidelines
- Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members
- Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively
- Be willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating a positive impact, and being diligent in delivering results
- Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet
- Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client data
- Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit)
- All other duties as assigned
Skills
- High School diploma or GED
- A minimum of one (1) to three (3) years of experience in customer service within a call center environment
- Excellent oral and written communication skills in English and Spanish
- Comprehensive command of the Spanish language with the ability to utilize it up to 35% of the time
- Good communication and telephone skills with a clear and concise speaking voice
- Demonstrated ability to learn new software and navigate multiple systems at once
- Moderate computing and keyboarding skills, including proficiency with Customer Relationship Management (CRM) software
- Ability to retain and apply knowledge of the various operations, products, and services of the organization, to provide excellent customer service support
- Ability to adapt to a constantly changing environment
- Proficient organizational and time management skills
- Ability to retain and apply knowledge of the various operations of the organization, products, and services to provide excellent customer service support
- Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds
- Home router with wired Ethernet (wireless connections and hotspots are not permitted)
- A designated room for your office or steps taken to protect company information (e.g., facing computer towards wall, etc.)
- A functioning smoke detector, fire extinguisher, and first aid kit on site
- Knowledge of Health Benefits, eligibility, application, and enrollment processes
- Knowledge of government regulations, federal states, and local health benefits programs
Benefits
- Affordable health benefit solutions
- Flexible work arrangements with work-from-home, in-office or hybrid options
- Competitive compensation packages
- Premier investment support
- Enriching personal development
- Profit-sharing
Company Overview
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