Bilingual Operations Specialist

If you’re looking for a career that provides affordable health benefit solutions to the people who support some of the most vital industries, we’re looking for you.

At Pinnacle Claims Management, we are an innovative third‑party administrator (TPA) that provides a full‑suite of comprehensive and customized health benefits administration services for self‑funded companies, including health management and wellness solutions, and pharmacy benefit management. We are also a proud contracted partner with Covered California. As part of the Western Growers Family of Companies, we are committed to providing our employees with everything they need to succeed and grow.

We know that taking care of our clients starts with taking care of our employees.

As a keystone of our philosophy, we recognize that every person on our team comes to us with a unique background, history and story that adds strength to our organization. Additionally, employees are encouraged to recognize that there isn’t a work life and a home life, there is one life. This recognition throughout the organization emphasizes the value of finding a healthy and happy balance in every employee’s life.

One way this is realized for employees of Pinnacle Claims Management is flexible work arrangements with work‑from‑home, in‑office or hybrid options.

With competitive compensation packages, premier investment support, enriching personal development and more, we strive for our employees’ job satisfaction and success.

Compensation: $38,625.60 - $48,750 with a rich benefits package that includes profit‑sharing.

Under the direction of the Senior Supervisor, Customer Service, the bilingual Child Care Providers United (CCPU) customer service representative provides consultive telephonic and web‑based assistance to Child Care Providers, Agents, and Enrollment Specialists in the Health Benefits Exchange administration. In addition, the incumbent will provide customer service support to individuals by instructing them on correct eligibility management procedures and troubleshooting application issues and concerns.

This position is also responsible for responding to general customer inquiries regarding insurance benefits, provider contracts, eligibility, and claims in a confidential, professional, and ethical manner.

• High School diploma or GED and a minimum of one (1) to three (3) years of experience in customer service within a call centre environment preferred.
• Excellent oral and written communication skills in English and Spanish, required.
• Comprehensive command of the Spanish language with the ability to utilize it up to 35% of the time.
• Knowledge of Health Benefits, eligibility, application, and enrollment processes preferred.
• Knowledge of government regulations, federal states, and local health benefits programmes preferred.
• Good communication and telephone skills with a clear and concise speaking voice.
• Demonstrated ability to learn new software and navigate multiple systems at once.
• Moderate computing and keyboarding skills, including proficiency with Customer Relationship Management (CRM) software.
• Ability to retain and apply knowledge of the various operations, products, and services of the organization, to provide excellent customer service support.
• Ability to adapt to a constantly changing environment.
• Proficient organisational and time management skills.
• Internet access provided by a cable or fibre 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.

• Foster and build good working relationships with Providers, Agents, Certified Enrollment Counselors, and federal and state agency contacts.
• Respond to customer questions telephonically or in writing regarding insurance benefits, provider contracts, eligibility, and claims confidentially, professionally, and ethically.
• Research and resolve aged customer…