Customer Service Representative

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)

Full-time