Case Review Representative – Bilingual (English/Spanish)

About the role

The Case Review Representative acts as the primary intake point for member and provider calls, handling tier‑one issues such as user resets, provider data management, fax and letter receipt, and general inquiries. The role supports operational needs across flexible rotational shifts.

Key responsibilities

• Work rotational shifts between 8 am‑8 pm EST, including weekdays and Saturdays as needed.
• Intake and label incoming faxes, create prior authorizations, and conduct Quality Performance Program outreach when assigned.
• Triage inbound calls, route case‑specific calls to the appropriate team member, and resolve tier‑1 issues.
• Manage inbound emails from health‑plan clients, route case‑specific emails, and resolve tier‑1 issues.
• Handle request/claims processing issues for health plans and support prior‑authorization creation.

Required profile

• College degree or relevant experience preferred.
• Fully bilingual in English and Spanish.
• Minimum of 2 years of administrative or customer‑service experience.
• Remote/hybrid work experience preferred.
• Ability to implement systems for program effectiveness and productivity.
• Proficiency with the MS Office Suite.

What we offer

• Full benefit package starting on the first day of employment.
• Company bonus program.