Located in Doral, FL
Pay: 20
Job Full Description
Bilingual Healthcare Customer Service Representative
We are seeking a bilingual Customer Service Representative to assist health plan members with questions regarding benefits, eligibility, coverage decisions, grievances, appeals, referrals and authorizations.
Responsibilities:
- Respond to member inquiries by phone, in writing and in person
- Explain plan benefits, eligibility, coverage and how to access services
- Assist with referrals, authorizations, ID card requests, grievances, appeals and coverage decisions
- Document member inquiries, complaints and resolutions
- Identify and route utilization management and coverage determination requests
- Coordinate with internal departments to resolve member concerns
- Follow CMS requirements and established response timeframes
- Maintain member confidentiality and comply with HIPAA requirements
- Assist elderly members and their families with questions and concerns
Requirements:
- Minimum of one year of healthcare industry experience
- Managed care or health plan experience preferred
- Must be fluent in English and Spanish
Miami (Doral-Hialeah Gardens), FL
2564
3625 Northwest 82nd Avenue
Suite 314
Doral, FL 33166
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