Bilingual Commercial Health Call Center Representative, Spanish

. Research, review, and respond to inbound and outbound member and provider inquiries .

Posted 9/25/2026full-timeRemote • United StatesJuniorMid-Level💰 $55,000 per yearWebsite

Key responsibilities & impact

Research, review, and respond to inbound and outbound member and provider inquiries
Resolve issues involving benefits, eligibility, claims, and billing at first contact when possible
Meet turnaround times and department metrics, including quality, AHT, ASA, and schedule adherence
Interpret and explain plan benefits, eligibility, cost-sharing, and claims payment decisions
Support providers with claim status, prior authorization requirements, and payment details
Support pharmacy and wellness vendor inquiries
Own initial intake and documentation of escalated member and provider situations
Collaborate with Claims, Medical Management, and other internal teams to resolve complex issues
Document every interaction in the designated CRM system
Monitor call and inquiry patterns to surface trends to leadership
Assist members with portal navigation and promote digital self-sufficiency

What you’ll need

High school diploma or equivalent required
2+ years of customer service experience supporting commercial fully insured health plan business
Working knowledge of commercial health plan benefits, eligibility, and claims processes
Demonstrated knowledge of CPT, ICD-10, HCPCS, and Revenue Codes
Microsoft 365 proficiency required
Fluency in both English and Spanish is required
Must live in/work from the United States in the CST or EST time zone
Dedicated work area separate from other living areas that provides information privacy
Ability to keep company sensitive documents secure
Must live in a location with existing high-speed internet service

Comp & perks