Bilingual Inbound/Outbound Support AgentFortuna BMC • Montgomery, AL, US
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Bilingual Inbound / Outbound Support Agent
Fortuna BMC • Montgomery, AL, US
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job_description.job_card.job_descriptionProvide enrollment assistance and guidance to Medicaid-eligible recipients and their families regarding the HIPP / Premium Assistance program via phone or correspondence. Verify, document, and investigate existing health coverage for Medicaid recipients and their dependents (employer plans, COBRA, etc.). Assist in identifying members who may qualify for HIPP / Premium Assistance. Obtain and verify documents required for eligibility : insurance policies, employment verification, premium invoices, etc. Maintain active case files during open enrollment cycles, premium review, and payment processing. Process, review, and follow up on premium payments / reimbursements, ensuring timely and accurate payments, and tracking any discrepancies. Perform ongoing case maintenance and audits, updating records for status changes, renewals, terminations, or escalations. Complete periodic reporting (e.g. case metrics, enrollment trends, audit reports) as required by state or internal stakeholders. Respond to high volumes of inbound and outbound calls and inquiries about eligibility, coverage, program rules, and status. Conduct advanced document review, legal research or case escalation as needed, particularly on more complex cases. Prioritize case events, manage deadlines, escalate issues to supervisors or subject matter experts when appropriate. Ensure strict adherence to HIPAA privacy and security standards when handling protected health information (PHI). Follow Medicaid, federal, and Alabama-specific HIPP / premium assistance rules, policies, and procedures. Support internal or external audits, submitting documentation and explanations for case decisions. Participate in training, quality assurance, and performance improvement programs related to case management operations. Coordinate with state Medicaid agency staff, other Gainwell teams, employers, insurers, and service providers as needed. Liaise with internal audit, legal, compliance, and escalation teams to resolve disputes or complicated cases. Provide feedback or suggestions to improve processes, workflows, policies, or system tools. At least 2 years of experience in health insurance, Medicaid, public health programs, or government-sponsored programs (or equivalent experience). At least 2 years of call center / phone-based experience (inbound and outbound) making inquiries, responding to recipients. Strong customer service, written and verbal communication skills Excellent organizational, detail orientation, and ability to work under deadlines Ability to analyze data, apply logical reasoning, and make informed decisions Proficiency in Microsoft Word, Excel, and familiarity with navigating web-based systems or internal tools Working knowledge of HIPAA privacy / security and handling of sensitive data Ability to handle stress, prioritize competing tasks, and escalate appropriately Professional demeanor, interpersonal skills, adaptability Preferred / Desired : Experience specifically with HIPP, premium assistance, Medicaid or health insurance programs Bilingual (especially in languages common in the region) Familiarity with health care / insurance terminology Previous experience with auditing, compliance, or fraud waste abuse program work
Bilingual Inbound / Outbound Support Agent
We are seeking a talented individual to join our team in supporting the HIPP / Premium Assistance program. This role involves proactive outreach (both outbound / inbound calls) to current members to collect the required documentation for annual case reviews. The ideal candidate will manage documentation verification, coordinate with members and employers, and deliver exceptional customer service while ensuring accurate data entry and timely processing. 6 month contract
Worksite : OnSite- Minimal (in-state) as required for training, meetings, audits
Work Schedule : Monday-Friday 8 : 00 AM-5 : 00 PM CST
Compensation : $17.00 Per Hour
What We Offer :
- Paid sick leave based on state regulations after 90 days of employment
- Medical, dental, and vision are offered after a waiting period (60% paid by Fortuna)
- Free TeleMedicine and Mental Health services for all employees and their families
- Additional voluntary benefits : Group Life Insurance, Accidental Insurance, Critical Care, Short Term Disability
What You'll Do :
What You'll Bring :
Fortuna operates as a staffing agency that sources, screens, and presents potential candidates for employment opportunities on behalf of our clients. Founded in 2012 by practicing professionals with more than 50 combined years of experience, Fortuna is headquartered in McClellan, California with offices in Los Angeles and New York, and satellite offices in the Philippines and Israel. Fortuna is an active member of multiple California service agreements, including the CMAS, ITMSA (Tier 2), and CalPERS SpringFed Pool, as well as various municipalities and large corporation vendor pools.
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