Bilingual Field Enrollment Specialist

Pinnacle Claims Management is an innovative third-party administrator providing comprehensive health benefits administration services. The Bilingual Field Enrollment Specialist is responsible for educating clients on program guidelines, processing claims, and delivering high-quality customer service support to ensure client satisfaction.

Responsibilities

• Provide timely and effective customer service to clients for requests, inquiries, or issues concerning enrollment and reimbursement items on their accounts, in person, via email and via the phone
• Provides support for overflow inbound calls as needed when not in the field
• Interface effectively with internal departments and external vendors, brokers, or other business contacts to coordinate interrelated activities and resolve eligibility and billing issues as they arise
• Serve as a representative of Pinnacle, displaying professionalism, knowledge, customer service, and discretion in all interactions with other members of the client community and their customers
• Educate prospective enrollees and existing program participants on eligibility requirements, program benefits, processes, and procedures at multiple on-site locations in California, via phone or virtual conference room
• Interface with third-party vendors/partners to communicate and educate them on benefits and programs specific to client programs and members
• Review and process claims in person and in the office in the company’s financial processing systems
• Review and enter manual requests for reimbursement into the company’s financial processing system on the provider’s behalf and process the request via OPS Connect
• Follow-up with members who need additional explanation regarding the documents needed for claims review and processing
• Research and correct client application, eligibility and claims issues reported in the field
• Contact clients to explain and resolve billing reimbursement discrepancies
• Identify inefficiencies within the established processes and suggest possible solutions to save time, reduce risk, and reduce expenses
• Create and document a minimum of one new Standard Operating Procedure (SOP) annually
• Identify, initiate, and implement at least one process improvement and/or innovation annually
• 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, be self-accountable, create a positive impact, and be 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)
• Maintain a clean DMV record and the ability to travel to locations throughout the U.S. (mainly California and Arizona) up to 50% of the time
• All other duties as assigned

Skills

• High school diploma or equivalent
• One (1) to three (3) years of customer service and/or accounting/business experience with knowledge of generally accepted accounting procedures, analytical abilities, or equivalent combination of education and experience
• Knowledge of generally accepted health care eligibility and billing procedures
• Knowledge of Health Insurance Portability and Accountability Act (HIPAA) and Employee Retirement Income Security Act (ERISA) legislation
• Excellent oral and written communication skills in English and Spanish, including modern business communications, formatting of professional letters, reports, and phone etiquette
• Comprehensive command of the Spanish language with the ability to utilize it up to 50% of the time
• Strong computer aptitude with Word, Excel, and Outlook and the ability to develop a strong proficiency working with a proprietary Health Care system
• Experience providing Customer Service to a variety of client contacts via email and telephone
• Strong ability to research and resolve technical issues or client problems as they arise with minimal direction
• Proficient written and oral communication skills including an ability to present material effectively in person
• Ability to establish priorities, multi-task, work under pressure and deadlines, and work independently with minimal supervision or in a team environment
• General knowledge of health insurance operations and industry
• 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
• Verifiable, clean DMV record and the ability to travel to various locations throughout the U.S. (mainly California and Arizona) up to 50% of the time

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