Bilingual Commercial Health Call Center Representative (Spanish)

Evry Healthcare Inc.; Dallas (TX); Hybrid; USD 50,000 - 61,000; Full time

Benefits offered by this job

Competitive salary

Comprehensive health, dental, and life

Retirement savings plan with company 9

Generous time off/vacation

Professional development opportunities

Flexible and remote work environment

Job summary

Evry Health is seeking a Biligual Customer Service Representative to be the primary contact for members and providers, handling calls and emails with empathy, delivering accurate information on benefits, eligibility, claims, and billing.

Candidates must have at least two years in customer service supporting a commercial health plan, be fluent in English and Spanish, and live/work in CST or EST time zones in the United States.

Qualifications

• 2+ years of customer service experience in a commercial health plan.
• Fluency in English and Spanish required.
• Working knowledge of CPT, ICD-10, HCPCS, and Revenue Codes.
• Experience with Salesforce or a comparable CRM is preferred.

Responsibilities

• Resolve member and provider inquiries regarding benefits, eligibility, claims and billing.
• Explain plan details and payment decisions clearly to members and providers.
• Own initial intake and documentation of escalated situations.
• Collaborate with Claims, Medical Management and other teams; document interactions in CRM.
• Assist members with portal navigation and promote digital self-service.

Skills

Customer service

Bilingual English/Spanish

CRM systems

Healthcare terminology

Education

Associate's or Bachelor's degree in business or healthcare

Tools

Salesforce

Microsoft 365

Job description

Role Summary

The Biligual Customer Service Representative is Evry Health's primary point of human contact for members and providers, serving as the face and voice of the company's commitment to accessible, accurate, and empathetic health insurance support. This role manages inbound and outbound calls and email inquiries with professionalism and care — delivering accurate, thorough information on commercial health plan benefits, eligibility, claims, and billing to ensure every member and provider interaction reflects Evry Health's mission of bringing humanity to health insurance. At least two years of experience in customer service supporting a commercial health plan (not just Medicare, Medicaid, or Pharmacy) is required. Eligible candidates also must live in/work from the United States in either the CST or EST time zone.

About Evry Health and Globe Life

We are on a mission to bring humanity to health insurance. Our high-technology health plans expand benefits, increase access and transparency, and feature a personalized, human approach. We strive to ensure members live happier, healthier lives.

Evry Health is the major medical division of Globe Life (NYSE:GL). Globe Life has 16.8 million policies in force, and more than 3,000 corporate employees and 15,000 agents. For more than 45 consecutive years, Globe Life has earned an A (Excellent) rating or higher from A.M. Best Company.

Roles and Responsibilities

• Member & Provider Inquiry Resolution: Researches, reviews, and responds to inbound and outbound member and provider inquiries, using knowledge of benefits, eligibility, claims, and billing to resolve issues at first contact when possible. Meets all turnaround times and department metrics, including quality, AHT, ASA, schedule adherence, etc.


• Benefits, Eligibility & Claims Explanation: Accurately interprets and explains plan benefits, eligibility, cost-sharing, and claims payment decisions, applying working knowledge of CPT, ICD-10, HCPCS, and Revenue Codes. Provides support to providers which includes claim status, prior authorization requirements, payment details. Supports pharmacy and wellness vendor inquiries.


• Escalation: Owns initial intake and documentation of escalated member and provider situations


• Cross-Functional Collaboration & Documentation: Collaborates with Claims, Medical Management, and other internal teams to resolve complex issues, and accurately documents every interaction in the designated CRM system.


• Trend Recognition & Member Portal Support: Monitors personal call/inquiry patterns to surface trends to leadership and assists members with portal navigation while promoting long-term digital self-sufficiency.

Qualifications

Required

• 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 & claims processes


• Demonstrated knowledge of CPT, ICD-10, HCPCS & Revenue Codes; Microsoft 365 proficiency required


• Fluency in both English and Spanish is required.

Pereferred

• Associate's or Bachelor's degree in business, healthcare, or related field


• Experience supporting Claims, Medical Management, and/or Appeals and Grievance functions


• Proficiency with Salesforce or a comparable CRM system


• Experience identifying/reporting call trends or serving in an informal team lead/quality capacity

Telecommuting Requirements

• This is a remote position. Our whole company works remotely. Company headquarters are in Dallas, Texas.


• Company business hours are weekdays 9-5 CST. We will only consider candidates in the United States who reside in the CST or EST time zones.


• Required to have a dedicated work area established that is separate from other living areas and provides information privacy.


• Ability to keep all company sensitive documents secure.


• Must live in a location that receives an existing high-speed internet connection/service.

Benefits Package

• Competitive salary


• Comprehensive health, dental, and vision insurance as well as life and disability


• Retirement savings plan with company match


• Generous time off/vacation


• Professional development opportunities


• Flexible and remote work environment

$55,000 - $55,000 a year