Bilingual Customer Service Representative- Provider Assistance (Tlacoquemecatl del Valle)

Job Description

Main daily responsibilities, but not limited to

• Register Policies in the system with proper eligibility, add Members/dependents and create appropriate tasks that will trigger proper workflow
• Documentation of all calls or communications in the Members record (when applicable)
• Confirmation of Benefits and Eligibility information to members and providers.
• Identify medical services that require an authorization from the Corporate Client and take appropriate actions (initiate authorization, provide status on existing ones and escalat(?) any issues to Case Management)
• Coordination of medical services in/outside the USA, this, in most cases, include locating and contacting several Providers who have the availability and suit the Members preferences and accept our Guarantee of Payment for a cashless experience
• Ensure that Providers send claims to the proper address for processing and/or payment and that o...