[Remote] Call Center Representative-Bilingual Spanish English

Note: The job is a remote job and is open to candidates in USA. Brighton Health Plan Solutions is a healthcare enablement company focused on improving how healthcare is accessed and delivered. They are seeking a Bilingual Spanish/English Call Center Representative to assist members and healthcare providers with inquiries regarding benefits, eligibility, and claims. The representative will handle inbound calls, resolve customer needs, and contribute to overall customer satisfaction.

Responsibilities
• Handle inbound calls from members, medical providers, and others.
• Adjust claims accurately, if needed.
• Listen to and address customer needs and concerns empathetically.
• Answer questions about fee schedules, network participation, and requirements.
• Ensure first contact resolution when possible.
• Update customer files and communicate effectively with teams.
• Transfer misdirected requests and offer solutions to non-routine issues.
• Contribute to customer satisfaction and business improvement.
• Use decision-support tools to provide accurate responses.
• Investigate inquiries using training and systems.
• Adapt responses to caller understanding.
• Educate callers and validate their understanding.
• Support projects and other departments as directed by management.

Skills
• Experience in a high-volume call center
• Experience with claims inquiry and claims review procedures
• Knowledge of medical specialties, fee schedules, complaints and appeals, and call center responsibilities
• Previous experience in a physician’s office, group practice, clinic or hospital-based practices
• Basic computer operations knowledge
• Intermediate proficiency in Microsoft Office (Word, Excel, Access, PowerPoint, Outlook)
• Strong time management skills
• General knowledge of HIPAA Confidentiality laws
• Quick learner with ability to grasp managed care procedures and claims payment policies
• Detail-oriented and dependable
• Effective listening and responding skills
• Flexible and adaptable to changes, with conceptual thinking
• Strong problem-solving abilities
• Excellent attendance and punctuality
• Comfortable performing tasks at a computer/telephone station
• Effective communication through various channels, including email, chat, and voice
• Bilingual Spanish/English
• Previous multi-channel experience is a plus

Education Requirements
• High School diploma with some college or business school education preferred

Company Overview
• Brighton Health Plan Solutions is a health care company that specializes in health plan management service. It was founded in 2016, and is headquartered in New York, New York, USA, with a workforce of 201-500 employees. Its website is https://brightonhps.com.