Participant Support Specialist – Bilingual, Spanish

Department: Call Center
Status: Full-Time


Our Participant Support Specialists are often the primary contact many of our customers and participants have with P&A. This means the Participant Support Specialist role is key to our success as an organization. The successful incumbent will actively demonstrate empathy, positive can-do behaviors with a keen desire to learn. Under direct supervision, and utilizing the training received, the Participant Support Specialist’s function is to provide effective and accurate responses to our callers, using in-depth knowledge of the customer’s plan(s) and program(s) as well as communicating effectively with internal team members throughout the department and organization. Strong proactive problem-solving and troubleshooting skills are key components of this role.  Effective performance of all duties and responsibilities of the position will assure accurate and timely completion of required tasks and compliance with required timelines.


Essential Functions

  • Answer incoming calls in
  • anish and English, interpret caller’s question/problem and provide resolution; researching solution(s) using available software, systems and processes
  • Provide individual participants guidance and resources on plan terms/content and eligibility in compliance with applicable regulations
  • Strive for first call resolution for all inquiries
  • Maintain data protection, privacy, security and maintain HIPAA compliance for participants and clients
  • Follow up with participants or administrators via phone or email to resolve open issues
  • Be logged into phones and chat software and available to take chats at all times. On chats always using excellent spelling and grammar
  • Assist less experienced representatives as appropriately
  • Proactivity: Look for call trends and patterns and proactively escalate suggestions for system/process improvements to Management based on observations and participant feedback
  • Accountability: Be ready to start work at scheduled start time; take responsibility for your workload and your own actions
  • Log all calls and chats in Flex Connect
  • Complete all required documentation
  • Performs all duties and responsibilities in a timely and effective manner in accordance with established department procedures
  • Keeps the Department Manager fully informed on all problems or unusual matters of significance and escalates when necessary
  • Takes direction from Participant Support Training Specialist, Sr. Manager, Customer Experience, Participant Support Supervisor and Lead Night PSS and any/all company managers and supervisors
  • Follow communication procedures, respond using appropriate decision trees, guidelines and policies


Other Functions

  • Perform folding and stuffing for Group Insurance Department as needed
  • Pre-index claims that are in Onbase when time permits
  • Completes any additional assignments as requested by the executive/management team members
  • Provide mentoring/support of team
  • Position incumbent is required to use some independent judgment to understand and apply decisions related to departmental policies and procedures, and administrative practices