Trilingual Customer Service Representative - MX

Job Description

As a Third-Party Administrator for international health insurance clients, the Trilingual Customer Service Representative is responsible for providing professional support to healthcare providers regarding patients covered under international, expatriate, destination, and travel insurance plans.

The representative serves as the primary point of contact for providers, assisting with billing questions, and claim status requests. This role requires effective communication with healthcare providers while ensuring timely resolution of inquiries and appropriate escalation when necessary.

Main daily responsibilities, but not limited to:

• Respond to inbound calls, emails, and portal communications from healthcare providers in a professional and timely manner.
• Assist providers with claim status inquiries, including processing status, payment details, and payment dates.
• Direct providers to the appropriate claims submission channels and ensure claims are submitted to the correct processing location.
• Assist in resolving provider billing concerns by coordinating with internal departments and other stakeholders.
• Investigate and identify discrepancies related to claims, payments, or provider billing issues and escalate when appropriate.
• Document all communications and actions accurately within company systems.
• Follow up on unresolved provider inquiries until resolution is achieved.
• Identify potential issues that may impact provider satisfaction and proactively seek resolution.
• Escalate complex cases, service concerns, or sensitive issues to management when appropriate.
• Maintain service quality standards while managing inquiries efficiently and accurately.
• Build and maintain positive relationships with healthcare providers through exceptional customer service.

This role requires managing a high volume of provider inquiries through calls, emails, and portals while maintaining accuracy, professionalism, and strong customer service. Key challenges include handling difficult conversations about claims, payments, and billing issues; investigating incomplete information; balancing productivity with service quality; prioritizing urgent cases; and ensuring detailed documentation. The position also requires effective communication in Spanish, English, and French.

Success is measured by meeting or exceeding service level targets, maintaining high quality standards (95%+ QA score), accurately documenting all interactions, achieving productivity goals, resolving issues on first contact, minimizing escalations and errors, completing follow-ups on time, and demonstrating strong attendance, compliance, training completion, and provider satisfaction.

Requirements:

• High School Diploma or Equivalent
• Trilingual (Spanish, English & French)
• 2+ years of customer service experience in a Call Center or Customer Service environment
• Demonstrated ability to resolve complex customer issues while maintaining a high level of professionalism.
• Prior experience working in a multilingual environment is an asset.
• Proficiency with Microsoft Office Suite (Outlook, Word, Excel, and Teams).
• Ability to navigate multiple systems simultaneously while speaking with providers.
• Strong data entry and documentation skills with a high level of accuracy.
• Must possess critical thinking skills as well as the ability to manage time efficiently.
• Needs to communicate well with co-workers (verbal and written).
• Knowledge of phone manners, etiquette and protocols.
• Professional phone etiquette and written skills
• Ability to adapt to changes
• Able to understand, interpret and explain policies and procedures as well as knowledge of commonly used concepts, practices and procedures in the field.
• Ability to deal with irate customers and complaints while maintaining composure and control of the situation.
• Knowledge of Microsoft Office.
• Ability to learn from past experiences.