Bilingual Call Center Representative

HealthFirst; Wyoming (MI); Remote; USD 42,000 - 66,000; Full time

Job summary

HealthFirst is hiring for a remote-based Customer Service role in the United States. You will handle inbound/outbound calls, manage LTC and Personal Care leads in Salesforce, and verify Medicaid/Medicare eligibility in ePACEs and Marx CMS.

The role requires English/Spanish fluency, strong communication skills, and the ability to meet daily targets while maintaining quality service. You will document interactions in Salesforce, coordinate appointments, and support multiple HealthFirst plans with

Qualifications

• High school diploma or GED.
• Fluency in reading and speaking English and Spanish.
• Member / Customer Service experience.
• Availability to work 8½ hour shifts per business needs.
• Occasional overtime.
• Remote work capability with reliable internet.
• Proficiency with Microsoft Office (Outlook, Excel, Word, PowerPoint).
• Organized, multitasking and detail-oriented.
• Cultural sensitivity and ability to handle fast-changing priorities.
• Ability to communicate with leaders via virtual platforms.

Responsibilities

• Handle inbound/outbound calls to address customer needs within SLAs.
• Create/follow up LTC leads in Salesforce for up to 90 days.
• Create/follow up personal care requests in Salesforce for Mainstream population (30 days).
• Answer calls or make outbound calls according to scripts.
• Search Medicaid eligibility/exemption codes in ePACEs.
• Search Medicare eligibility/enrollments in Marx (CMS).
• Aim to meet daily/weekly/monthly growth goals.
• Document calls, outcomes and special instructions in Salesforce.
• Schedule field and tele-video appointments for SHP Intake Nurses and HF teams.

Skills

Bilingual English/Spanish

Customer service experience

Tech-savvy: MS Office

Education

Associate degree or higher

High school diploma or GED

Tools

Salesforce

Marx (CMS)

ePACEs

Job description

Duties and Responsibilities

• Handling inbound and outbound calls to and from customers to address their needs while adhering to internal Service Levels standards.
• Creates and/or follow ups for up to 90 days on Long-Term Care (LTC) Leads and Opportunities entered in Salesforce.
• Create and/or follow ups for up to 30 days on Personal Care services requests for the Mainstream population in Salesforce.
• Answer all calls or complete outbound calls according to approved scripts.
• Searches ePACEs for Medicaid eligibility, exclusion, and exemption codes.
• Searches in Marx (CMS) for Medicare eligibility, enrollments, and special elections.
• Achieves daily, weekly, and monthly growth goals.
• Handle all calls to maximize productivity and optimal operational efficiency.
• Connects consumers seeking personal care/long term care services with the State broker to complete the initial evaluation.
• Schedules all field and tele video conference appointments for SHP Intake Nurses in Salesforce.
• Schedules all field and tele video conference appointments for HF CompleteCare Specialist and Intake Nurses in Salesforce.
• Schedules Entitlement Advocates appointments for SHP and HF Complete Care prospective members with a Medicaid coverage issue or restriction.
• Schedules Clinical Assessors to complete Community Health Assessments for Mainstream/HARP members requesting Personal Care Services at home.
• Documents all incoming/outbound calls under call tracking in Salesforce
• Documents all outcomes in pre-enrollment database system.
• Documents all special instructions in Salesforce
• Coordinates the preparation of fulfillment kits / brochures to prospective members or those requesting addition information in a timely manner.
• Troubleshoots and follows up on LTC enrollment rejections.
• Handles other duties as assigned with the occasional need to work weekends, additional hours before or after shift scheduled.
• Engage in mastering the Divisions impact on all Healthfirst Plans and its members.
• Ability to create a positive impression during first contact with prospective members by setting the tone and being able to immediately demonstrate product knowledge and credibility with the goal of maximizing the number of scheduled appointments to achieve daily, weekly, and monthly goals. Persuasive and able to establish trust.
• Additional duties as assigned.

Minimum Qualifications

• High school diploma or GED.
• Fluency in reading and speaking English and Spanish
• Member / Customer Service experience.
• Availability to work for 8 ½ hours shift, based on business needs, within our hours of operations: Monday - Friday 8:00 AM - 8:00 PM and Saturdays 10:00 AM - 6:30 PM. 8:00 AM to 8:00 PM Monday -Sunday during open enrollment (October - March). Initial Training schedule may vary from permanent assigned schedule.
• Occasional overtime.
• Capability to work in a remote environment with reliable internet connection.
• Tech Savvy computer skills such as Microsoft Office Suites: Outlook, Excel, Word, PowerPoint
• Organized and multi-tasking capabilities and detail oriented.
• Understanding of and sensitivity to cultural differences and needs of the community are essential.
• Adept at working in an environment with fast-past changing priorities including high stress while achieving quota expectations.
• Available to communicate / engage with your leaders via Virtual platforms (emails, MS Teams and others)

Preferred Qualifications

• Work experience within the healthcare industry
• Experience with Medicare or Medicaid managed care plan products such as, Family Health Plus (FHP), Eastern Benefits System (EBS) and/or Federal Employee Program (FEP). (Preferred)
• Associate degree or higher from an accredited institution.
• Extensive work experience including inbound and outbound call center with telemarketing responsibilities within a healthcare environment.
• Healthfirst product knowledge of Complete Care, Senior Health Partners (SHP) or managed long-term care.
• Prior experience engaging / communicating with the frail adult or elderly population.
• A solid understanding of the value of integrated care.
• Experience in health insurance, home care environment, acute, sub-acute, long-term care (LTC) setting or managed-long term care (MLTCP).
• Experience managing member information or appointments in a shared network environment using paperless database modules.
• Adept at operating within a multi-cultural work environment and community of Members such as Spanish, Chinese, Southeast Asian and others.
• Ability to maintain a calm, neutral disposition while managing many details in a distracting environment

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to or calling . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC.Know Your RightsAll hiring and recruitment at Healthfirst is transacted with a valid "@healthfirst.org" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

Hiring Range

• Greater New York City Area (NY, NJ, CT residents): $48,600 - $65,960
• All Other Locations (within approved locations): $42,200 - $62,400

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role.