Member Services Representative- Bilingual Spanish

Johnson Service Group, Inc.; Irvine (CA); On-site; USD 26,000 - 32,000; Full time

Job summary

Johnson Service Group (JSG) is seeking a Member Service Representative to support health insurance inquiries. This remote role requires residing in PST, MT or Central Time Zone. You will handle benefits, eligibility, and reimbursement questions with accuracy while collaborating across departments.

Pay rate: $21.00 per hour. Responsibilities include handling calls, emails, and case management; educating clients on eligibility; resolving discrepancies and processing claims.

Qualifications

• 1–3 years of claims, accounting, or customer service experience.
• Fluency in English and Spanish with excellent speaking and writing skills.
• Strong knowledge of health insurance procedures: eligibility, billing, and regulatory compliance.

Responsibilities

• Provide exceptional customer service via phone, email, and case management for benefits, claims, and reimbursements.
• Educate clients on program eligibility and guidelines; resolve issues in real time.
• Research and resolve eligibility discrepancies; process claims and ensure accuracy across systems.

Skills

Bilingual English/Spanish

Customer service

Time management

Independent work

Microsoft Office

Education

High school diploma or equivalent

Tools

Microsoft Office

Case Management Systems

EDI (Nice to have)

Job description

Johnson Service Group (JSG) is seeking Member Service Representatives to help support health insurance inquiries. -Remote- Must Live in PST, MT or Central Time Zone. This exciting role offers the opportunity to deliver exceptional customer service and support to key clients, ensuring their benefit, eligibility, and reimbursement needs are managed efficiently and accurately. Join a collaborative team where your language skills and healthcare knowledge can make a real difference in people's lives, all while working remotely within a supportive company culture. Pay rate: $21.00 per hour.

What You’ll Do:

• Provide exceptional customer service via phone, email, and case management to assist clients with benefits, claims, and reimbursements.
• Educate clients on program eligibility and guidelines, resolving issues related to reimbursements and claims in real-time.
• Research and resolve eligibility discrepancies, process claims, and ensure accuracy across internal systems.
• Maintain compliance with HIPAA and ERISA regulations while managing sensitive client information.
• Collaborate across departments to streamline processes, report on performance metrics, and suggest process improvements to enhance efficiency.

Required Skills:

• Fluency in both English and Spanish, with excellent speaking and writing skills.
• 1-3 years of claims, accounting, or customer service experience, or a related educational background.
• Strong knowledge of health insurance procedures, including eligibility, billing, and regulatory compliance.
• Proficiency in Microsoft Office Suite and basic computer systems.
• Exceptional time management, multitasking, and problem-solving abilities.
• Ability to work independently or within a team, maintaining professionalism and accuracy.

Nice to Have Skills:

• Prior experience with case management systems and Electronic Data Interchange (EDI).
• Knowledge of health insurance laws such as HIPAA and ERISA.
• Experience handling health care reimbursement and claims processing.

Preferred Education and Experience:

• High school diploma or equivalent required.
• Healthcare-related background or previous claims/customer service work is highly preferred.

Other Requirements:

• Ability to work remotely in a designated, secure workspace with wired Ethernet internet connection.
• Flexibility to work typically from 8 am – 5 pm PST, with some hours ranging from 7:55 am to 5:15 pm.
• May be required to attend at least one in-person customer engagement annually.
• Certification or additional training in health care billing or customer service is a plus, but not mandatory.

JSG offers medical, dental, vision, life insurance options, short-term disability, 401(k), weekly pay, and more.

Johnson Service Group (JSG) is an Equal Opportunity Employer.

JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law.

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