Remote Bilingual Health Insurance Support Specialist

Evry Healthcare Inc.; United States; Remote; USD 42,000 - 65,000; Full time

Benefits offered by this job

Health, dental, vision insurance and</

Life and disability insurance

Retirement plan with company match

Generous time off

Professional development

Flexible remote work

Job summary

Evry Health is seeking a Bilingual Customer Service Representative to be the primary point of contact for members and providers, handling inbound/outbound calls and emails with empathy. You will explain benefits, eligibility, claims, and billing while ensuring high-quality, timely resolutions in a fully remote US environment.

The role requires at least 2 years in customer service for a commercial health plan, fluent English and Spanish, and positions in CST or EST time zones.

Qualifications

• 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.

Responsibilities

• Member & Provider Inquiry Resolution: researches, reviews, and responds to inquiries using benefits, eligibility, claims, and billing knowledge to resolve issues at first contact when possible.
• Benefits, Eligibility & Claims Explanation: interprets and explains plan benefits, eligibility, cost-sharing, and claims decisions; supports providers with claim status and prior authorization details.
• Escalation: owns initial intake and documentation of escalated member and provider situations.
• Cross-Functional Collaboration & Documentation: collaborates with Claims, Medical Management, and other teams and documents interactions in the CRM system.
• Trend Recognition & Member Portal Support: monitors inquiry patterns to surface trends and assists portal navigation.

Skills

Customer service

Bilingual English/Spanish

Microsoft 365

Healthcare benefits knowledge

CPT/ICD-10 knowledge

CRM familiarity

Education

High school diploma or equivalent

Tools

Salesforce

Microsoft 365

Job description

Evry Health is seeking a Bilingual Customer Service Representative to be the primary point of contact for members and providers, handling inbound/outbound calls and emails with empathy. You will explain benefits, eligibility, claims, and billing while ensuring high-quality, timely resolutions in a fully remote US environment.

The role requires at least 2 years in customer service for a commercial health plan, fluent English and Spanish, and positions in CST or EST time zones.