Astrana Health · 14 hours ago
Customer Service Representative I (Spanish Speaking)
United States
Full-time
Remote
Entry Level
$20/hr - $20/hr
1+ years expAstrana Health is looking for a Customer Service Representative to join their fast and growing team. This role requires fluent Spanish speaking skills and involves handling daily calls from members, providers, and other stakeholders while providing quality service and resolving concerns.
Health CareMedical
Responsibilities
Answer all daily telephone calls from members, providers, health plans, insurance brokers, collection agents and hospitals
Collect Elicit information from members/providers including the problem or concerns and provide general status information
Verify authorization, claims, eligibility, and status only
All calls carefully documented into Company’s customer service module & NMM Queue system
Member/Provider Service/Representative assists Supervisor and Manager with other duties as assigned
Member outreach communications via mail or telephone
Assist Member appointment with providers
Resolve walk-in member concerns
Able to provide quality service to the customers
Able to communicate effectively with customers in a professional and respectful manner
Maintain strictest confidentiality at all times
Specialist termination notifications sent to members
Urgent Medicare Authorization Approval – Notification to Medicare members
Transportation arrangement for Medicare & Medi-Cal members
Outreach Project Assignments
All calls carefully documented into Company’s customer service module
Annual Wellness Visit (AWV) – Gift card pick up and schedules
Appointment of Representative (AOR) for Medicare Members
Attorney / Third Party Vendor calls
Authorization status/Modification/Redirection/CPT Code changes/Quantity adds/Explain Denied Auth/Peer to Peer calls/Extend expired auth/Pre-certified auth status/Retro/2ndor 3rd opinion/
Conduct 3 way conference call to Health Plan with member
Conference call with Providers – Appointments, DME
COVID – 19 related questions (Tests & Vaccines)
Direct Member Reimbursement (DMR)
Eligibility – Demographic changes: Address/Phone/Fax Changes/Name change
Escalated calls from providers/members
Health Diary Passport
Health Source MSO – Assist & arrange inquiries on Eligibility/Change PCP/Benefit with AHMC
HIPPA Consent – Obtain Member Consent verification
Inquiries on provider network/provider rosters
Lab locations
Member & Provider Complaints/Grievances
Member bills
Miscellaneous calls
Pharmacy – Drug/medication pick up and coverage
Provide authorization status for Hospital /CM Dept
Self-Referral Request for Medicare
Return Mail
Track Mail Packages/ Certified mail status
Translations – Spanish / Chinese
Urgent Care / locations/ operations hours
Assist Case Management on CCS – age in 21 years for change of PCP from Pediatrics to FP/IM
Assist Marketing on email inquiries
Assist PR/ Elig – Members assigned to wrong PCP/with no PCP status
Assisted UM / Medical Directors on urgent member appointment from escalated cases
Authorization status response call back
Benefits – return call once information is obtained / verified
Complaints/Grievances – return calls once resolution is obtained
DME – Translation support in Spanish and Chinese to confirm item / appointment set up for DME department
Eligibility – return call to providers/labs when member is added to system while waiting at the office
Member bills – return calls once resolution is obtained
Member Survey – Annually: every 4thquarter
Outreach project from internals – QCIT
Resolve walk in members concerns
Specialist Termination notification sent to members
Transportation arrangement for Medicare / Medi-Cal members
Voice mail – return calls back to callers
Assist to contact new members/IPA member transfer on new PCP assignment as needed
Work group discussions on work status/progress on new member/IPA transfer
Update call log and provide daily/weekly status as needed
Facilitate members with complex pre-existing conditions, medications, PCP/SPC network reviews
Conference call with PCP selection / change
Help member to identify member bill status, connect provider with on billing and claim submission
Responsible for experience of the membership associated with new member/IPA transfer
Responsible for to interact with Health Plan’s Customer Service Team to serve new member/IPA transfer
Problem Solving complex cases/ brain storm with MS management team for resolution
Other duties as assigned
Qualification
Required
High School Diploma or GED
Experience using Microsoft applications such as Word, Excel and Outlook
Experience working in customer service
One year related experience and/or training; or equivalent combination of education and experience
You are fluent in Spanish
Preferred
You have previous work experience working in a healthcare setting
Company
Astrana Health
Leading physician-centric, technology-powered, risk-bearing healthcare mgmt. company delivering high quality care in a cost-effective manner
1001-5000 employees
Funding
Current Stage
Public CompanyTotal Funding
$334.36MKey Investors
Network Medical ManagementFresenius Medical Care
2019-09-26Post Ipo Equity· $300M
2017-12-20Post Ipo Equity· $5.2M
2017-12-08IPO
Leadership Team
Brandon Sim
Chief Executive Officer & President
Sherry McBride
Chief Operating Officer, MSO
Recent News
2025-12-31
2025-11-11
Company data provided by crunchbase