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.