Bilingual Field Enrollment Specialist

Pinnacle Claims Management is an innovative third-party administrator providing comprehensive health benefits administration services. The Bilingual Field Enrollment Specialist is responsible for educating clients on program guidelines, processing claims, and delivering high-quality customer service support to ensure client satisfaction. Responsibilities - Provide timely and effective customer service to clients for requests, inquiries, or issues concerning enrollment and reimbursement items on their accounts, in person, via email and via the phone - Provides support for overflow inbound calls as needed when not in the field - Interface effectively with internal departments and external vendors, brokers, or other business contacts to coordinate interrelated activities and resolve eligibility and billing issues as they arise - Serve as a representative of Pinnacle, displaying professionalism, knowledge, customer service, and discretion in all interactions with other members of the client community and their customers - Educate prospective enrollees and existing program participants on eligibility requirements, program benefits, processes, and procedures at multiple on-site locations in California, via phone or virtual conference room - Interface with third-party vendors/partners to communicate and educate them on benefits and programs specific to client programs and members - Review and process claims in person and in the office in the company’s financial processing systems - Review and enter manual requests for reimbursement into the company’s financial processing system on the provider’s behalf and process the request via OPS Connect - Follow-up with members who need additional explanation regarding the documents needed for claims review and processing - Research and correct client application, eligibility and claims issues reported in the field - Contact clients to explain and resolve billing reimbursement discrepancies - Identify inefficiencies within the established processes and suggest possible solutions to save time, reduce risk, and reduce expenses - Create and document a minimum of one new Standard Operating Procedure (SOP) annually - Identify, initiate, and implement at least one process improvement and/or innovation annually - Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members - Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively - Be willing to adjust efforts to ensure that work and attitude are helpful to others, be self-accountable, create a positive impact, and be diligent in delivering results - Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet - Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client data - Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit) - Maintain a clean DMV record and the ability to travel to locations throughout the U.S. (mainly California and Arizona) up to 50% of the time - All other duties as assigned Skills - High school diploma or equivalent - One (1) to three (3) years of customer service and/or accounting/business experience with knowledge of generally accepted accounting procedures, analytical abilities, or equivalent combination of education and experience - Knowledge of generally accepted health care eligibility and billing procedures - Knowledge of Health Insurance Portability and Accountability Act (HIPAA) and Employee Retirement Income Security Act (ERISA) legislation - Excellent oral and written communication skills in English and Spanish, including modern business communications, formatting of professional letters, reports, and phone etiquette - Comprehensive command of the Spanish language with the ability to utilize it up to 50% of the time - Strong computer aptitude with Word, Excel, and Outlook and the ability to develop a strong proficiency working with a proprietary Health Care system - Experience providing Customer Service to a variety of client contacts via email and telephone - Strong ability to research and resolve technical issues or client problems as they arise with minimal direction - Proficient written and oral communication skills including an ability to present material effectively in person - Ability to establish priorities, multi-task, work under pressure and deadlines, and work independently with minimal supervision or in a team environment - General knowledge of health insurance operations and industry - Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds - Home router with wired Ethernet (wireless connections and hotspots are not permitted) - A designated room for your office or steps taken to protect company information (e.g., facing computer towards wall, etc.) - A functioning smoke detector, fire extinguisher, and first aid kit on site - Verifiable, clean DMV record and the ability to travel to various locations throughout the U.S. (mainly California and Arizona) up to 50% of the time Benefits - Affordable health benefit solutions - Flexible work arrangements with work-from-home, in-office or hybrid options - Competitive compensation packages - Premier investment support - Enriching personal development - Profit-sharing Company Overview - Pinnacle Claims Management provides a spectrum of health benefits administration services to self-funded employers in all industries. It was founded in 1996, and is headquartered in Irvine, California, USA, with a workforce of 201-500 employees. Its website is https://www.pinnacletpa.com/.