[Remote] Bilingual Operations Specialist I

Note: The job is a remote job and is open to candidates in USA. Pinnacle Claims Management is an innovative third-party administrator that provides comprehensive health benefits administration services. The Bilingual Operations Specialist I will assist Child Care Providers and Agents with telephonic and web-based support, focusing on eligibility management and troubleshooting application issues. Responsibilities - Foster and build good working relationships with Providers, Agents, Certified Enrollment Counselors, and federal and state agency contacts - Respond to customer questions telephonically or in writing regarding insurance benefits, provider contracts, eligibility, and claims confidentially, professionally, and ethically - Research and resolve aged customer service open calls within company standards - Obtain and extract information from the Health Care Processing System (HCPS) and other systems - Develop and maintains positive customer relations and coordinate with various departments to ensure customer requests and questions are handled appropriately and promptly - Be accountable and resolve issues by measuring impact, improving, and correcting course - Adhere to the call center’s quality assurance guidelines to ensure best-in-class service is provided during all interactions - Thoroughly document information, activities, inquiry outcomes, and changes in the database for accurate tracking and analysis - Research and analyze data to address operational challenges and customer service issues - Provide external and internal customers with the requested information - Communicate with the appropriate departments and identifies service issues - Identify inefficiencies within the established processes and suggest possible solutions to save time, reduce risk, and reduce expenses - Meet and maintain all KPIs to support the department service metrics and performance objections - Maintain regular attendance per employee handbook guidelines - Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members - Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively - Be willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating a positive impact, and being diligent in delivering results - Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet - Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client data - Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit) - All other duties as assigned Skills - High School diploma or GED - A minimum of one (1) to three (3) years of experience in customer service within a call center environment - Excellent oral and written communication skills in English and Spanish - Comprehensive command of the Spanish language with the ability to utilize it up to 35% of the time - Good communication and telephone skills with a clear and concise speaking voice - Demonstrated ability to learn new software and navigate multiple systems at once - Moderate computing and keyboarding skills, including proficiency with Customer Relationship Management (CRM) software - Ability to retain and apply knowledge of the various operations, products, and services of the organization, to provide excellent customer service support - Ability to adapt to a constantly changing environment - Proficient organizational and time management skills - Ability to retain and apply knowledge of the various operations of the organization, products, and services to provide excellent customer service support - Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds - Home router with wired Ethernet (wireless connections and hotspots are not permitted) - A designated room for your office or steps taken to protect company information (e.g., facing computer towards wall, etc.) - A functioning smoke detector, fire extinguisher, and first aid kit on site - Knowledge of Health Benefits, eligibility, application, and enrollment processes - Knowledge of government regulations, federal states, and local health benefits programs Benefits - Affordable health benefit solutions - Flexible work arrangements with work-from-home, in-office or hybrid options - Competitive compensation packages - Premier investment support - Enriching personal development - Profit-sharing Company Overview - Pinnacle Claims Management provides a spectrum of health benefits administration services to self-funded employers in all industries. It was founded in 1996, and is headquartered in Irvine, California, USA, with a workforce of 201-500 employees. Its website is https://www.pinnacletpa.com/.