Bilingual Customer Care Agent

2 weeks ago

Irvine, California, United States Western Growers Family of Companies Full time


If you are seeking a fulfilling career that offers accessible health benefit solutions to those who support essential industries, we invite you to consider joining our team.

At Pinnacle Claims Management, a forward-thinking third-party administrator (TPA), we deliver a comprehensive range of tailored health benefits administration services for self-funded organizations. Our offerings include health management, wellness solutions, and pharmacy benefit management. As a proud partner of Covered California and a member of the Western Growers Family of Companies, we are dedicated to equipping our employees with the tools they need to thrive and advance. We believe that exceptional client care begins with prioritizing our employees' well-being.

We value the unique backgrounds and experiences each team member brings, which strengthens our organization. We encourage our employees to recognize the importance of a harmonious work-life balance, emphasizing that life is a single journey rather than two separate entities. To support this philosophy, we offer flexible work arrangements, including options for remote, in-office, or hybrid work.

With competitive salary packages, excellent investment support, and opportunities for personal growth, we are committed to ensuring our employees' job satisfaction and success.

Compensation: $38, $48,750 with a comprehensive benefits package that includes profit-sharing.

Job Overview

Under the guidance of the Senior Supervisor, Customer Service, the bilingual customer service representative for Child Care Providers United (CCPU) delivers consultative support via telephone and online platforms to Child Care Providers, Agents, and Enrollment Specialists involved in Health Benefits Exchange administration. The representative will also assist individuals by guiding them through eligibility management procedures and troubleshooting application-related issues. This role entails responding to general inquiries about insurance benefits, provider agreements, eligibility, and claims in a confidential, professional, and ethical manner.
Qualifications
  • High School diploma or GED and a minimum of one (1) to three (3) years of experience in customer service within a call center environment preferred.
  • Excellent oral and written communication skills in English and Spanish are required.
  • Strong command of the Spanish language with the ability to utilize it up to 35% of the time.
  • Familiarity with health benefits, eligibility, application, and enrollment processes preferred.
  • Understanding of government regulations and local health benefits programs preferred.
  • Effective communication and telephone skills with a clear and articulate speaking voice.
  • Proven ability to learn new software and navigate multiple systems simultaneously.
  • Moderate computing and keyboarding skills, including proficiency with Customer Relationship Management (CRM) software.
  • Ability to retain and apply knowledge of the organization's various operations, products, and services to provide outstanding customer service support.
  • Capacity to adapt to a dynamic environment.
  • Strong organizational and time management skills.
  • Access to a reliable internet connection provided by a cable or fiber provider with a minimum of 40 MB download and 10 MB upload speeds.
  • A home router with wired Ethernet (wireless connections and hotspots are not permitted).
  • A designated workspace that ensures the protection of company information.
  • A functioning smoke detector, fire extinguisher, and first aid kit on site.
Responsibilities

Customer Advocacy
  • Develop and maintain positive working relationships with Providers, Agents, Certified Enrollment Counselors, and relevant agency contacts.
  • Address customer inquiries via phone or in writing regarding insurance benefits, provider agreements, eligibility, and claims in a confidential, professional, and ethical manner.
  • Investigate and resolve outstanding customer service calls in accordance with company standards.
  • Extract and obtain information from the Health Care Processing System (HCPS) and other relevant systems.
  • Foster positive customer relations and collaborate with various departments to ensure timely and appropriate handling of customer requests.
  • Take ownership of issues by measuring impact, improving processes, and making necessary adjustments.
  • Adhere to quality assurance guidelines to ensure exemplary service is provided during all interactions.
Call Center Support
  • Accurately document information, activities, inquiry outcomes, and changes in the database for effective tracking and analysis.
  • Analyze data to address operational challenges and customer service issues.
  • Provide both external and internal customers with the requested information.
  • Communicate with relevant departments to identify and resolve service issues.
  • Identify inefficiencies within established processes and propose solutions to enhance efficiency and reduce costs.
  • Meet and maintain all key performance indicators (KPIs) to support departmental service metrics and performance objectives.
Other
  • Maintain regular attendance in accordance with employee handbook guidelines.
  • Utilize all capabilities to support our mission of enhancing the competitiveness and profitability of our members. Strive to understand others' goals and work collaboratively to achieve them.
  • Ensure compliance with internet speed requirements and maintain a wired Ethernet connection.
  • Uphold a HIPAA-compliant workstation and implement appropriate security measures to protect confidential client data.
  • Maintain and service safety equipment as required.
  • Perform other duties as assigned.
Physical Demands/Work Environment

The physical demands and work environment described here represent those that an employee must meet to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. While performing the duties of this position, the employee is regularly required to communicate with others and frequently move around the office. The employee is often required to use tools, objects, and controls. The noise level in the work environment is typically moderate.

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