[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.ResponsibilitiesFoster and build good working relationships with Providers, Agents, Certified Enrollment Counselors, and federal and state agency contactsRespond to customer questions telephonically or in writing regarding insurance benefits, provider contracts, eligibility, and claims confidentially, professionally, and ethicallyResearch and resolve aged customer service open calls within company standardsObtain and extract information from the Health Care Processing System (HCPS) and other systemsDevelop and maintains positive customer relations and coordinate with various departments to ensure customer requests and questions are handled appropriately and promptlyBe accountable and resolve issues by measuring impact, improving, and correcting courseAdhere to the call center’s quality assurance guidelines to ensure best-in-class service is provided during all interactionsThoroughly document information, activities, inquiry outcomes, and changes in the database for accurate tracking and analysisResearch and analyze data to address operational challenges and customer service issuesProvide external and internal customers with the requested informationCommunicate with the appropriate departments and identifies service issuesIdentify inefficiencies within the established processes and suggest possible solutions to save time, reduce risk, and reduce expensesMeet and maintain all KPIs to support the department service metrics and performance objectionsMaintain regular attendance per employee handbook guidelinesUtilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our membersDo 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 collaborativelyBe 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 resultsMaintain internet speed of 40 MB download and 10 MB upload and router with wired EthernetMaintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client dataMaintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit)All other duties as assignedSkillsHigh School diploma or GEDA minimum of one (1) to three (3) years of experience in customer service within a call center environmentExcellent oral and written communication skills in English and SpanishComprehensive command of the Spanish language with the ability to utilize it up to 35% of the timeGood communication and telephone skills with a clear and concise speaking voiceDemonstrated ability to learn new software and navigate multiple systems at onceModerate computing and keyboarding skills, including proficiency with Customer Relationship Management (CRM) softwareAbility to retain and apply knowledge of the various operations, products, and services of the organization, to provide excellent customer service supportAbility to adapt to a constantly changing environmentProficient organizational and time management skillsAbility to retain and apply knowledge of the various operations of the organization, products, and services to provide excellent customer service supportInternet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speedsHome 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 siteKnowledge of Health Benefits, eligibility, application, and enrollment processesKnowledge of government regulations, federal states, and local health benefits programsBenefitsAffordable health benefit solutionsFlexible work arrangements with work-from-home, in-office or hybrid optionsCompetitive compensation packagesPremier investment supportEnriching personal developmentProfit-sharingCompany OverviewPinnacle 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/.



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