Job Description

Job Description

Job Description

Description: As a Customer Service Representative, you will be responsible for providing phone guidance to customers and/or insured individuals, according to their requests and needs, ensuring resolution on the first contact. You will be a key part of the service experience by offering professionalism, courtesy, and excellence.

Essential Duties:

• Confers with enrollees by telephone to provide information about services of their respective healthcare insurance plan.
• Provides orientation, support and education services on non-clinical matters related to different plan coverage’s and promotions.
• Manages incoming calls and refer calls to the appropriate resources according to the enrollee specific needs.
• Documents records transactions, recording details of inquiries, as well as actions taken.
• Refers unresolved customer grievances to his/her supervisor or to designated departments for further investigation.
• Provides support to other projects of Contact Center.
• Conducts phone interviews (outbound calls) to enrollees regarding services, satisfaction levels and follow up activities.
• Participates in trainings and development sessions.
• Ensures confidentiality and compliance with all state and federal regulations applicable to Health Call Centers; including HIPAA and internal policy for disposing of confidential information material.
• Notifies any expose of Protected Health Information to the supervisor immediately.
• Complies with medullar & functional trainings; and all procedures established by regulatory agencies, contractual requirements and any applicable certification standards (including but not limited to URAC, among others).

Requirements:

• Minimum of one (1) year of Customer Service experience.
• High School Diploma completed and/or university credits (preferred).
• Advanced knowledge in computer applications and/or Microsoft Office.
• Customer service-oriented and committed.
• Excellent verbal and written communication skills.
• Fully Bilingual (Spanish and English)
• Fast documentation and internet navigation.
• Availability for rotating shifts (including weekends/holidays), Monday to Sunday 24/7.

What are the benefits of being part of our team as a Service Representative in the Health field?

• Training in service, regulatory aspects, and health.
• 24/7 telemedicine service.
• Employee health and wellness programs
• Opportunity for growth and development.
• Contribute to the health and well-being of the population.
• Benefits of paid leave

Job Type: Full-time

Workplace: Hybrid remote in Guaynabo or Mayaguez, PR 00965

EQUAL EMPLOYMENT OPPORTUNITY EMPLOYER - (EEOC)

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