Note: The job is a remote job and is open to candidates in USA. Gainwell Technologies is a company focused on enhancing healthcare through innovative solutions. They are seeking a Bilingual Healthcare Customer Service Representative to provide expert assistance in insurance and healthcare, respond to customer inquiries, and ensure service level agreements are met. The role involves working remotely from Florida, contributing to a team dedicated to improving the health and well-being of vulnerable communities.

Responsibilities

• Answers telephones and responds to basic customer questions and/or forwards to appropriate personnel and 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 and 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. Advises provider review councils, state officials and works with organized healthcare groups and associations on various medical issues related to insurance and healthcare programs
• 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
• Interfaces with team members, management, and customers in reference to customer service issues. Review and recommends modification to procedures and workflow as necessary to ensure efficient and effective processing of transactions

Skills

• Bilingual proficiency in English and Spanish is required
• 2 or more years of customer service experience in any industry
• Knowledge of basic help desk software, computer software and Microsoft Office applications
• Strong problem-solving skills to bring inquiries to effective resolution
• Strong customer service skills with an emphasis on written and oral communication to respond to inquiries professionally
• Ability to understand your role on a team and identify the correct stakeholders to consult to resolve client inquiries

Benefits

• All salaried, full-time candidates are eligible for our generous, flexible vacation policy
• A 401(k) employer match
• Comprehensive health benefits
• Educational assistance
• A variety of leadership and technical development academies to help build your skills and capabilities
• Most benefits start on first day of employment
• Remote (work from home)

Company Overview