Job Description
Job Description
Job Description:
As a Customer Service Representative, you will be responsible for providing telephone guidance to clients and/or insured members, according to their requests and needs, ensuring first-contact resolution. You will play a key role in the service experience by offering professionalism, courtesy, and excellence.
Essential Duties:
-
Communicates with members by phone to provide information about their respective health insurance plan services.
-
Offers guidance, support, and educational services on non-clinical matters related to the different plan coverages and promotions.
-
Manages incoming calls and refers them to the appropriate resources based on the member’s specific needs.
-
Documents and records transactions, including details of inquiries and actions taken.
-
Refers unresolved customer complaints to a supervisor or designated departments for further investigation.
-
Supports other Contact Center projects.
-
Conducts outbound phone interviews with members regarding services, satisfaction levels, and follow-up activities.
-
Participates in training and development sessions.
-
Ensures confidentiality and compliance with all applicable state and federal health call center regulations, including HIPAA and internal policies for handling confidential information.
-
Immediately reports any Protected Health Information (PHI) exposure to the supervisor.
-
Complies with core and functional trainings, as well as all procedures established by regulatory agencies, contractual requirements, and applicable certification standards (including but not limited to URAC).
Requirements:
-
Minimum of one (1) year of experience in Customer Service.
-
Completed high school and/or university credits (preferred).
-
Advanced knowledge of computer applications and/or Microsoft Office.
-
Strong customer service orientation and commitment.
-
Excellent verbal and written communication skills.
-
Fast documentation and internet navigation skills.
-
Availability for rotating shifts (including weekends/holidays), Monday to Sunday from 7:00 a.m. to 7:00 p.m.
What are the benefits of joining our team as a Health Services Representative?
-
Training in service, regulatory aspects, and healthcare.
-
24/7 Telemedicine service.
-
Free employee health and wellness programs.
-
Opportunities for growth and development.
-
Contributing to the health and well-being of the population.
-
Paid leave benefits.
Position Type: Full-time or Part-time
Work Location: On-site position in Guaynabo or Mayagüez, PR
EQUAL EMPLOYMENT OPPORTUNITY EMPLOYER (EEOC)