[Remote] Bilingual Operations Specialist I

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