Bilingual Call Center Representative

Job DescriptionSHP Bilingual SpanishJob SummaryUnder direct supervision, the Customer Service Representative handles customer inquiries, including but not limited to claims and benefit interpretation. The Customer Service Representative services prospective members, enrolled members, providers, employers, vendors, and other Health Net customers. This position is responsible for resolving all aspects of customer inquiries and complaints, for providing accurate and timely responses, and for entering accurate information into the customer database.Essential Duties & Responsibilities Demonstrates regular, reliable and predictable attendance. Handles general inbound ACD calls, correspondence, and lobby visits related to all aspects of service. Effectively communicates, written and verbally, Health Net policies, procedures, and applicable benefits to members and/or providers who have misinterpreted, were unaware of, or are questioning a Health Net policy or decision. Researches claims according to established policies and procedures. Determines claim status and consults with appropriate staff and/or management on all questionable claims in order to ensure proper disposition. Must meet departmental standards for quality, productivity and teamwork. Communicates accurate information to customer questions and requests, by phone and/or in writing, in a courteous and professional manner. Able to handle difficult and sensitive issues appropriately; maintains highest level of customer confidentiality. Investigates customers' problems as indicated. Initiates appropriate action to ensure timely resolution. Interacts with staff in other departments to clarify problems presented by customers and to obtain accurate information. Develops and maintains a comprehensive knowledge of all Health Net policies, procedures, products and services including departmental processes of Medical Management, Network Management, Sales & Marketing and Government Programs. Identifies, analyzes and performs any of the following: Member/Provider eligibility and benefit questions and research Research and interpretation of claims, including all aspects of COB, NF, Worker's compensation and claim recovery All correspondence including internet correspondence, emergency room appeals, member and employer questionnaires, enrollment applications and Authorization Services forms Referrals/Authorizations research Facilitates filing of appeals and grievances Plans (including all Non-Standard Plans, ASO, and Government Programs) Enrollment and Eligibility Benefit Product comparisons, Exclusions, Limitations, and Product nuances Interpret Health Net remittance advices and member EOB's Performs data input in a highly accurate and timely fashion for all customer contacts according to the customer information database system parameters. Assures documentation is complete, so department is able to monitor physician compliance. Participates in various training and information functions available to the Health Plan Operations staff members to enhance skills, improve performance, and contribute to the ongoing development and achievement of departmental goals. Has an understanding of, and is able to communicate member benefits, reimbursement policies, coding guidelines, the appeal and grievance procedures, andEducationHigh School DiplomaCertification/Licensure RequiredN/AGovernment Clearance & US Citizenship RequirementN/AExperience RequiredSome experience in customer service or telemarketing, medical terminology, claim processing desired Experience with HMO, insurance carrier or Third Party Administrator desired Or any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.Knowledge, Skills & AbilitiesMust be a self-starter with a strong desire to provide superior customer service Computer skills and familiarity with Window applications, with typing ability of 30 wpm required Ability to interact professionally with both internal and external contacts Able to work flexible hours, including weekends and evenings, as department or training needs dictate, and at the discretion of management Good written, oral and interpersonal communication skills Ability and desire to work in a fast paced environment is requiredWorking ConditionsOperates personal computers, printers, facsimile, telephones, copy machines and other commonly used office accessories/equipment.Exposed to confidential information and expected to maintain confidentiality at all times; must adhere to HIPAA rules and regulations.May be required to work outside of normally scheduled hours as mandated by the client, project and/or workload (e.g. evenings, weekends, and/or holidays).May be required to maintain established work pace, meet deadlines; may have last minute urgent requests.Physical activity may include: twisting, reaching, kneeling, bending, stooping, squatting, crawling, grasping, grabbing, pushing, pulling, repetitive motion, climbing, etc.Required to have visual acuity to determine the accuracy, neatness, and thoroughness of the work assigned.Required to have hearing ability to receive detailed information through oral communication.Required to have speaking ability to express or exchange ideas.Constant concentration may be required on various subjects by listening, reading and thinking clearly.Interaction with others may be required. May need to listen, think, and speak in order to interact with others. Business interactions and behavior between coworkers and/or external customers are required. This may require face-to-face or telephone interactions.Thinking at work may include listening, learning, analyzing, evaluating, and the ability to interpret what is seen and/or heard, or to link information from one issue to the next.Constant computer usage including typing and/or eye strain.Significant repetitive arm, wrist, hand and finger motions -- making repetitive movements (e.g. key boarding, filing, data entry).Constant phone usage; headsets may be required.Constant amount of time spent working in a loud office environment with frequent interruptions/distractions.Constant sedentary work (desk bound or seated).Constant reading is required via computer screen and/or bound printed materials.DisclaimerDISCLAIMER: The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this job. They are not intended to be construed as an exhaustive list of responsibilities, duties and skills required of personnel so classified.Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.Health Net and its subsidiaries are an Equal Opportunity/Affirmative Action Employer - Minorities/Females/Veterans/Disability Why Kelly®?At Kelly Services®, we work with the best. Our clients include 95 of the Fortune 100™ companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talent to drive their business forward. If you only make one career connection today, connect with Kelly. About Kelly Services® As a workforce advocate for over 70 years, we are proud to directly employ nearly 500,000 people around the world and have a role in connecting thousands more with work through our global network of talent suppliers and partners. Revenue in 2016 was $5.3 billion. Visit kellyservices.com and connect with us on Facebook, LinkedIn and Twitter. Kelly Services is an equal opportunity employer including, but not limited to, Minorities, Females, Individuals with Disabilities, Protected Veterans, Sexual Orientation, Gender Identity and is committed to employing a diverse workforce. Equal Employment Opportunity is The Law.]]