Bilingual Claims Resolution Specialist (English & Spanish)

Kavi Software Technologies Private Limited; Chennai District; On-site; INR 300,000 - 520,000; Full time

Job summary

Kavi Software Technologies Private Limited is hiring for a Bilingual Claims Resolution Specialist to support our US healthcare claims processing team. The role requires fluency in English and Spanish (oral and written) to communicate with patients, employers, attorney representatives, insurers, and other parties.

The candidate will handle claim information gathering, data entry, and correspondence in both languages, using the client’s systems, ensuring HIPAA compliance and timely reimbursements.

Qualifications

• Diploma or Bachelor's degree in any discipline.
• Fresher or 1+ year US Healthcare BPO experience.
• Experience in US healthcare insurance/claims processing preferred.

Responsibilities

• Contact patients, employers, attorney representatives, insurers, and other parties in the US in English and Spanish to gather information for claims.
• Analyze and evaluate complex claim payments using proprietary software and tools.
• Perform data entry and review of payment documentation for reimbursement status.
• Conduct timely follow-up to ensure receipt of documents and prompt reimbursement.
• Prepare initial bill packets and related correspondence in English and Spanish.

Skills

Spanish fluency

English fluency

Communication skills

Typing fast

Multi-tasking

Organization

Attention to detail

Education

Diploma or Bachelor's degree

Tools

Microsoft Office

Windows OS

Job description

Kavi Software Technologies Private Limited | Full time

Position Summary

We are hiring freshersand experienced professionals to join our healthcare claims processing team asa Bilingual Claims Resolution Specialist. This role requires fluency inboth English and Spanish (oral and written) to communicate effectivelywith patients, employers, attorney representatives, insurance companies, andother responsible parties in the United States. The specialist serves as aliaison between key client contacts and end patients/employers/attorneys, primarilythrough phone, email, and written correspondence.

Responsibilities

• Contactend patients, employers, attorney representatives, insurance companies, andother responsible parties in the US using both English and Spanish to gatherinformation required to complete claims.
• Analyzeand evaluate complex claim payments using the client's proprietary software,systems, and tools.
• Usepayment documentation provided by payers to determine reimbursement status andperform accurate and timely data entry.
• Conducttimely and thorough telephone follow-up with payers and other responsibleparties to ensure claims and supporting documentation have been received andfacilitate prompt reimbursement.
• Preparecomplex claim initial bill packets, appeal letters, and related correspondencein English and Spanish, as required, using the client's systems and tools.
• Assistin obtaining supporting claim documentation, compiling billing packets, andfiling insurance claims accurately and efficiently.
• Translateand interpret claim-related information and communications between English andSpanish while maintaining accuracy and professionalism.
• Fileand handle confidential documentation and Patient Health Information (PHI) incompliance with HIPAA guidelines and company policies.
• Meetor exceed monthly Quality Audit metrics and Production targets consistently.
• Collaborateeffectively with team members to improve operational efficiency and claimresolution outcomes.
• Assistwith operational research and identify process improvement opportunities.
• Performother duties as assigned.

Education

• Diplomaor Bachelor's Degree in any discipline; OR
• Fresher/ 1+ years of experience in a US Healthcare BPO environment.

Experience

• Experienceworking in a US-based BPO, US healthcare insurance industry, medical billing,claims processing, or related healthcare support environment preferred.
• Proficiencyin Microsoft Office Suite and Windows-based applications.

Skills and Prerequisites

• Fluentin Spanish and English (oral and written) with excellent communication, comprehension, andinterpersonal skills.
• Abilityto pass a bilingual language proficiency assessment (English and Spanish).
• Strongverbal communication skills with the ability to interact professionally withpatients, employers, attorneys, insurance representatives, and client contacts.
• Fastand accurate typing skills while maintaining live conversations.
• Abilityto multitask effectively between data entry, research, and phone conversations.
• Strongwritten communication skills for preparing professional correspondence,appeals, and claim documentation in both languages.
• Abilityto communicate professionally and confidently via phone, email, fax, and othercommunication channels.
• Strongattention to detail and ability to manage high volumes of work accurately.
• Abilityto thrive in a fast-paced environment and work under limited supervision.
• Strongorganizational skills with the ability to prioritize multiple assignments andmeet deadlines.
• Abilityto effectively communicate issues, risks, and project impacts to management andstakeholders.
• Professionaldemeanor with the ability to interact at all levels within the organization.