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Bi-Lingual Health Care Customer Service Representative

Company: Gainwell
Location: Tallahassee
Posted on: May 6, 2021

Job Description:

Job Description:Essential Job Functions* Answers telephones and responds to basic customer questions and/or forwards call to appropriate personnel.* 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.* 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.* Provides directions for utilization review.* Records call on account history record with results of the inquiry; initiates required confirmation without direct supervision. Researches customer inquiries and responds to appropriate parties in a timely manner.* Processes customer requests by sending emails, or using other related communication.* 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.* Advises provider review councils, state officials and works with organized healthcare groups and associations on various medical issues relate to insurance and healthcare programs.* Interfaces with team members, management, and customers in reference to customer service issues.* Reviews and recommends modification to procedures and workflow as necessary to ensure efficient and effective processing of transactions.* Speak and Understand English and Spanish fluently

Keywords: Gainwell, Tallahassee , Bi-Lingual Health Care Customer Service Representative, Sales , Tallahassee, Florida

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