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Bilingual (Spanish) Resolution Specialist

DescriptionThis position is responsible for providing high quality client focused service by using knowledge of local, state and federal program requirements to efficiently maintain and update general applicant information, financial, medical and personal information to support client applications.

• Documents and updates the PACE (Patient Advocacy at Change Healthcare System) based on daily contact of select members of assigned applicant group and application evidence requirements, i.e. work activity, medical condition, third party, beneficiary, contact and demographic data financial, life and health insurance information, employment and salary verification, medical history and documentation where evidence is required.
• Reviews inbox for daily work queues, identifies missing evidence and follows through to completion
• Answers incoming calls from clients and Health Care Representatives
• Assists callers in resolving account issues by identifying and taking appropriate actions including completing required forms to support application process
• Effectively educates and answers inquiries from patients and family representatives regarding application process
• Assists clients with scheduling appointments and reminding of appointments, as needed
• Maintains ongoing communication with other internal Resolve Application functions to obtain information and/or provide updates regarding claim status
• Identifies and takes appropriate actions to complete and submit required financial, medical and personal information forms to support the client application process
• Reviews software system for document mailings prior to applications, medical records, etc. is packaged and mailed to external sources
• Receives calls and assists clients, company representatives and Healthcare Reps in resolving evidence application issues
• Diligently follows-up with institutions/businesses resolving issues ultimately affecting application approval
• Identifies appropriate escalation points and works with Escalation Team Leader to resolve issues
• Reviews outgoing client material for accuracy prior to submittal
• Complies with ethics, privacy and compliance policies and procedures

Requirements• High school graduate or GED required, some college preferred
• Prior work experience in a healthcare environment preferred
• Knowledge of application requirements and processes for SSA and DDS programs
• Knowledge of medical terminology and business principles
• Previous customer service experience required
• Strong communication skills (verbal & written); demonstrated experience working with high volume of phone calls
• Skill in identifying problems, researching and recommending resolutions
• Resourceful and tenacious when faced with obstacles
• Professional phone demeanor required
• Strong organization skills – ability to prioritize, plan, and follow through
• Ability to work independently
• Ability to work collaboratively with others
• Ability to maintain effective working relationships with clients, the public and business contacts
• Ability to react calmly and competently when discussing medical situations with clients
• Ability to perform effectively as a team member, supporting a client-focused environment
• Proficient computer skills in Microsoft products: Outlook, Word, Excel and PowerPoint
• Bilingual Spanish a plus