Bilingual Customer Service Representative – Work from Home

March 18, 2021
Houston, TX
Job Type


Bilingual Spanish Call Center Representative – Work From Home


The Bilingual Inbound Contacts Representative 2 serves as a member advocate, addressing customer needs, which may include acting upon complex benefit needs, resolving grievances, and educating members. The Bilingual ICR 2 documents member inquiries and resolutions provided per Centers for Medicare and Medicaid compliance criteria. The Bilingual ICR 2 role intakes calls, makes outbound calls, resolves grievances and follows the escalation protocol when necessary to address member needs. Bilingual ICR 2 role must adhere to the member services department protocols that speak to plan benefits as well as align to CMS mandates in the handling of organization/coverage determinations, grievances and appeals. This role is a highly structured role requiring continuous referencing of policies and protocols. Active listening and the intention to work in a proactive manner is key to success in the role. Role does require ongoing receptiveness to training and performance feedback, as compliance mandates are continuously updating and we are audited against our adherence to these.

Additional Details

Work Environment: This is a customer-centric member advocate environment focused on high quality outcomes versus activities. Our department primarily communicates over the phone, but we are not a “call center" environment as we are responsible for the member’s safety and advocacy outcome as part of the continuum of their care. We value quality work as every action taken in the member services department is to facilitate access to the member and avoid adverse outcomes for the member.

  • Associates can expect to take anywhere from 25 to 35 inbound calls per day with the focus being on high-quality service with a strong emphasis on member advocacy and patient safety.
  • While this associate receives inbound calls, up to 60% to 70% of these calls may require associates to place outbound calls to physicians, DME vendors, pharmacies or other entities to coordinate benefits and care for the member.
  • This role calls for strong emotional intelligence focused on proactively providing solutions, ensuring the member's utmost health and safety. De-escalation skills are a must to thrive in this role. We serve a wide variety of members, some of which are experiencing illness and trauma at the time of their call.

Required Qualifications

Education, Experience, Skill set:

  • High School Diploma or Equivalent
  • 2+ years of customer service experience such as in a Physician Medical Office, Clinical Unit/Office Coordination role, or any experience working with irate member population requiring high degree of organization, structure and focus.
  • Candidate must be interested in the health insurance industry, Medicare Care Advantage industry, or compliance industry as this opportunity is not a job, but an opportunity to learn the
  • intricacies of a Medicare Advantage Prescription Drug Plan (PDP). This role is a learning opportunity to build a career from. Candidate must understand they will serve the member as a “Universal Agent" which requires knowledge and mastery of multiple disciplines such as but not limited to: pharmacy; plan medical, dental & vision benefits, case management, compliance requirements and more.
  • Excellent verbal and written communication skills
  • Must be willing to comprehend complex compliance mandates and inter-dependencies that exist within the operation.
  • Ability to maintain a professional demeanor, practicing strict confidentiality on all platforms for all sensitive information
  • Ability to focus on the training and role without significant interruption during the workday.
  • Strong initiative with the ability to adapt to change as the business requires.
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences
  • Must have the ability and willingness to be selfless and focus on the member as the priority throughout the workday.

Technology, System, and Platform Knowledge Strong computer skills and utilizing multiple systems and applications simultaneously is required as this is a work at home role. Must be comfortable with gaining new systems knowledge at all times as software is constantly updating requiring the ability to learn systems real time. The following is required to ensure success in the role as a remote work at home associate:

  • Must be proficient in Microsoft Word such as Word, Excel, Outlook/WebEx, Skype and using collaborative platforms for network sharing examples such as SharePoint, and Teams
  • Must have experience using vendor applications examples such as Salesforce, and department CRM Platforms.
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