Note: The job is a remote job and is open to candidates in USA. MagnaCare is focused on improving healthcare access and delivery. They are seeking a Bilingual Customer Service Representative who will assist members and healthcare providers with benefits, eligibility, and claims inquiries while ensuring customer satisfaction through effective communication and problem-solving.
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
- Fluent in both English and Spanish
- High School diploma with some college or business school education preferred
- 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
- Previous multi-channel experience is a plus
Company Overview
MagnaCare, a division of Brighton Health Plan Solutions, has been a leading and trusted Third Party Administrator for over 30 years. It was founded in 1990, and is headquartered in New York, New York, USA, with a workforce of 201-500 employees. Its website is http://www.magnacare.com.
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