Job Description
Job Description
Description:
As a Bilingual Customer Service Representative, you will be responsible for providing phone guidance to clients and/or insured members, according to their requests and needs, ensuring a resolution on the first contact. You will be a key player in delivering an exceptional service experience by offering professionalism, courtesy, and excellence.
Essential Functions:
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Communicates with members by phone to provide information regarding services covered by their respective health insurance plan.
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Provides guidance, support, and educational services on non-clinical matters related to different plan coverages and promotions.
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Manages incoming calls and refers them to appropriate resources based on the member’s specific needs.
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Documents and records transactions, including details of inquiries and actions taken.
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Refers unresolved customer complaints to a supervisor or designated departments for further investigation.
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Provides support in other Contact Center projects.
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Conducts outbound calls to members to gather information about services, satisfaction levels, and follow-up activities.
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Participates in training and development sessions.
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Ensures confidentiality and compliance with all applicable state and federal health call center regulations, including HIPAA and internal policies for the disposal of confidential information.
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Immediately notifies their supervisor of any Protected Health Information exposure.
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Complies with core and functional training, as well as with 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 one (1) year of Customer Service experience.
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High school diploma completed and/or university credits (preferred).
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Advanced knowledge of computer applications and/or Microsoft Office.
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Strong orientation and commitment to customer service.
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Excellent verbal and written communication skills.
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Bilingual (Spanish and English).
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Fast documentation and internet navigation skills.
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Availability for rotating shifts (including weekends/holidays), Monday through Sunday, 24/7. A shift differential is provided.
What are the benefits of joining our team as a Health Services Representative?
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Training in service, regulatory aspects, and health.
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24/7 telemedicine service.
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Free health and wellness programs for employees.
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Growth and development opportunities.
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Contribute to the health and well-being of the population.
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Paid leave benefits.
Job Type: Full-time
Work Location: Hybrid Remote in Guaynabo, PR
EQUAL OPPORTUNITY EMPLOYER – (EEOC)