Benefits Eligibility Agent (Bilingual - English/Spanish)

Benefits Eligibility Agent (Bilingual - English/Spanish)

Job Description

 
Job Title: Benefits Eligibility Agent  (Bilingual - English/Spanish)

Department: Operations 
Reports To: Lead / Operations Manager 
Location: Remote 
Employment Type: Full-Time 
Scope: Phone-Based Support 

Job Summary 

The Benefits Eligibility Agent provides phone-based administrative and operational support to Case Managers by assisting in the preparation, coordination, and submission of insurance applications. This role requires frequent outbound and inbound phone communication with families, healthcare facilities, and insurance offices to gather information, follow up on documentation, and resolve application-related issues. The ideal candidate is detail-oriented, reliable, and proactive, with strong communication skills and the ability to work aligned with U.S. business hours in a remote environment.

Work Schedule 

• Schedule: Monday to Friday, 9:00 AM – 6:00 PM 
• Time Zone: Must be able to work U.S. time zones 
• Daylight Savings: Work hours may shift slightly during U.S. Daylight Saving Time 

Essential Job Functions 
(Listed in order of importance with approximate % of time. Total equals 100%.) 

1. Phone-Based Insurance Application Support – Conduct outbound and inbound phone calls to assist Case Managers with preparing, reviewing, and submitting insurance applications. Confirm required information, clarify details, and ensure applications are completed and submitted within established deadlines - 35%
2.  Data Collection & Documentation Management – Gather, verify, and organize documentation obtained via phone conversations, email, and internal systems. Ensure all records are accurate, complete, and properly documented to support application processing - 25%
3. Stakeholder Communication & Follow-Up – Communicate professionally by phone with families, insurance offices, healthcare facilities, and internal team members to obtain missing information, provide updates, and resolve inquiries in a timely manner - 20%
4. Issue Resolution & Process Support – Collaborate closely with Case Managers to identify and resolve application issues, proactively addressing delays or challenges discovered through phone interactions - 10%
5. Administrative & Operational Support – Complete assigned administrative tasks, call logs, and follow-up tracking to ensure smooth day-to-day operations of the insurance application support team - 10%

 
Required Qualifications (Knowledge, Skills & Experience) 

• High School Diploma, with 1-2 Years of BPO Experience. 

• MUST speak both Spanish & English.
• Strong organizational and time management skills with the ability to manage multiple tasks and deadlines. 
• Excellent phone communication skills, with a professional, clear, and empathetic manner when speaking with families, healthcare facilities, and government offices. 
• Strong written communication skills for accurate documentation and follow-ups. 
• High attention to detail and accuracy when handling sensitive and confidential information. 
• Ability to work independently, take ownership of tasks, and collaborate effectively within a team while being responsive, responsible, goal-oriented, and diligent with a strong work ethic and accountability mindset. 

 
Preferred Qualifications 

• Previous experience in a phone-based support role, healthcare administration, insurance 
processing, or case management support. 
• Experience communicating with U.S. government agencies or healthcare providers. 
• Familiarity with remote work environments and call documentation systems. 

Work Conditions / Physical Demands / Travel Requirements 

This position operates in a fully remote, phone-intensive environment and requires a quiet, professional workspace, a reliable high-speed internet connection, and the ability to manage frequent calls throughout the workday. The role involves extended periods of computer and headset use and requires strict adherence to confidentiality, data protection, and company policies. 

Important Notes 

• This is a call-driven role requiring consistent outbound and inbound phone activity during U.S. business hours. 
• Responsibilities may evolve based on operational or regulatory needs. 
• Accuracy, professionalism, confidentiality, and timeliness are critical due to the sensitive nature of insurance -related information. 

Disclaimer 

This job description outlines the general nature and level of work performed and is not an 
exhaustive list of duties. Responsibilities may be adjusted to meet business needs. 

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