Job Description
Job DescriptionJoin Our Team!
The Clinical Screener provides general information and non-clinical guidance to enrollees, including, but not limited to, Medicare, Medicaid, Commercial, and Government Health Plan enrollees, over the telephone. This role supports clinical staff through the management and follow-up of non-clinical matters and general administrative tasks.
Additionally, there are opportunities to provide services to clients in the United States, allowing you to expand your professional experience in a dynamic and international environment.
Key Responsibilities
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Follow the Nurse Advice Line scripts when handling different topics.
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Identify customer needs, clarify information, research each situation, and provide appropriate solutions.
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Manage incoming calls, validate the reason for the call, and route customers to the Nurse Advice Line or Customer Service, as appropriate.
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Document enrollee interactions and transactions, including details of calls, complaints, and comments, as well as actions taken.
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Take messages from incoming calls when all Registered Nurses are busy at the time of the call.
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Refer unresolved customer concerns or grievances to the supervisor or designated departments for further investigation.
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Schedule and coordinate Telemedicine appointments with medical staff.
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Provide support for other Nurse Advice Line projects.
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Ensure confidentiality and compliance with all state and federal regulations applicable to healthcare call centers, including HIPAA, as well as internal policies regarding the proper disposal of confidential information.
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Immediately notify the supervisor of any exposure or disclosure of Protected Health Information (PHI).
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Comply with core and functional training requirements, as well as all procedures established by regulatory agencies, contractual requirements, and applicable certification standards, including, but not limited to, URAC.
Requirements
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Minimum of 1 year of Customer Service experience.
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High school diploma (college credits preferred).
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Knowledge of computer applications and Microsoft Office.
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Excellent verbal, written, and reading communication skills.
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Bilingual in Spanish and English preferred, especially for opportunities providing services to clients in the United States.
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Strong customer service orientation, empathy, and a proactive attitude.
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Availability to work rotating 24/7 shifts (Monday through Sunday, including weekends and holidays).
Benefits
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Specialized training in customer service, healthcare regulations, and health-related topics.
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24/7 telemedicine services.
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Free employee health and wellness programs.
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Professional growth and development opportunities.
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Paid leave.
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Retirement plan.
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The opportunity to positively impact the well-being of the population.
Location: Hybrid in Guaynabo or Mayagüez, PR | Remote work may be available, as applicable.
Employment Type: Full-time | Temporary
We are an Equal Employment Opportunity (EEOC) employer.