Claims Customer Service Representative (Bilingual)

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We are seeking a Claims Customer Service Representative (Bilingual) for one of our clients over in Brookhaven, Ga. The Claims Customer Service Representative is responsible for handling high-volume inbound calls from policyholders and healthcare providers. This role focuses on resolving claim-related inquiries, providing accurate insurance information, and delivering excellent customer service with an emphasis on first-call resolution.
Key Responsibilities
Handle a high volume of inbound customer service calls in a professional and efficient manner
Respond to inquiries related to insurance policies, benefits, coverage, and claims
Aim for first-call resolution while maintaining a positive customer experience
Assist healthcare providers with claim processing and submission guidance
Explain claim adjudication outcomes, reimbursement procedures, and policy details
Ensure compliance with Medicare, CMS, and industry regulations
Accurately document all customer interactions and claim-related activity
Escalate complex or unresolved issues to the appropriate department
Collaborate with internal teams to support efficient claims and service operations
Required Qualifications Strong knowledge of Medicare Supplement and other applicable insurance products
Bilingual proficiency in English and Spanish required, with the ability to clearly communicate insurance and claims information to diverse audiences.
Understanding of healthcare claim adjudication processes
Experience in a high-volume inbound call environment
Excellent verbal and written communication skills
Strong problem-solving skills and attention to detail
Ability to work independently and collaboratively within a team
Proficiency with customer service systems, databases, and related tools
Education High school diploma or equivalent
Skills & Competencies Customer service excellence
Empathy and patience with customers and providers
Clear and effective communication
Time management and multitasking in a fast-paced environment
Attention to accuracy and documentation
Adaptability to changing policies, guidelines, and procedures
Location: Brookhaven, GA Job Type : Onsite | Direct Hire | Full-Time
Pay Details: $45,000.00 to $50,000.00 per year
Search managed by: Coleman Harris
Equal Opportunity Employer/Veterans/Disabled
Military connected talent encouraged to apply
To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to https://www.lhh.com/us/en/candidate-privacy
The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable: The California Fair Chance Act Los Angeles City Fair Chance Ordinance Los Angeles County Fair Chance Ordinance for Employers San Francisco Fair Chance Ordinance
Massachusetts Candidates Only: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
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Location:
Brookhaven
Category:
Office And Administrative Support Occupations

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