Bilingual Claims Resolution Specialist (English & Spanish)

Bilingual Claims Resolution Specialist (English &
Spanish)

Position Summary

We are hiring freshers
and experienced professionals to join our healthcare claims processing team as
a Bilingual Claims Resolution Specialist. This role requires fluency in
both English and Spanish (oral and written) to communicate effectively
with patients, employers, attorney representatives, insurance companies, and
other responsible parties in the United States. The specialist serves as a
liaison between key client contacts and end patients/employers/attorneys, primarily
through phone, email, and written correspondence.

Responsibilities

●      Contact
end patients, employers, attorney representatives, insurance companies, and
other responsible parties in the US using both English and Spanish to gather
information required to complete claims.

●      Analyze
and evaluate complex claim payments using the client's proprietary software,
systems, and tools.

●      Use
payment documentation provided by payers to determine reimbursement status and
perform accurate and timely data entry.

●      Conduct
timely and thorough telephone follow -up with payers and other responsible
parties to ensure claims and supporting documentation have been received and
facilitate prompt reimbursement.

●      Prepare
complex claim initial bill packets, appeal letters, and related correspondence
in English and Spanish, as required, using the client's systems and tools.

●      Assist
in obtaining supporting claim documentation, compiling billing packets, and
filing insurance claims accurately and efficiently.

●      Translate
and interpret claim -related information and communications between English and
Spanish while maintaining accuracy and professionalism.

●      File
and handle confidential documentation and Patient Health Information (PHI) in
compliance with HIPAA guidelines and company policies.

●      Meet
or exceed monthly Quality Audit metrics and Production targets consistently.

●      Collaborate
effectively with team members to improve operational efficiency and claim
resolution outcomes.

●      Assist
with operational research and identify process improvement opportunities.

●      Perform
other duties as assigned.

●       

Education

●      Diploma
or Bachelor's Degree in any discipline; OR

●      Fresher
/ 1+ years of experience in a US Healthcare BPO environment.

Experience

●      Experience
working in a US -based BPO, US healthcare insurance industry, medical billing,
claims processing, or related healthcare support environment preferred.

●      Proficiency
in Microsoft Office Suite and Windows -based applications.

Skills and Prerequisites

●      Fluent
in Spanish and English (oral and written) with excellent communication, comprehension, and
interpersonal skills.

●      Ability
to pass a bilingual language proficiency assessment (English and Spanish).

●      Strong
verbal communication skills with the ability to interact professionally with
patients, employers, attorneys, insurance representatives, and client contacts.

●      Fast
and accurate typing skills while maintaining live conversations.

●      Ability
to multitask effectively between data entry, research, and phone conversations.

●      Strong
written communication skills for preparing professional correspondence,
appeals, and claim documentation in both languages.

●      Ability
to communicate professionally and confidently via phone, email, fax, and other
communication channels.

●      Strong
attention to detail and ability to manage high volumes of work accurately.

●      Ability
to thrive in a fast -paced environment and work under limited supervision.

●      Strong
organizational skills with the ability to prioritize multiple assignments and
meet deadlines.

●      Ability
to effectively communicate issues, risks, and project impacts to management and
stakeholders.

●      Professional
demeanor with the ability to interact at all levels within the organization.

●      Timely
and regular attendance.