Customer Service Representative

Triple-S; Guaynabo (PR); On-site; USD 34,000 - 52,000; Full time

Job summary

Triple-S is seeking a detail-oriented professional to support health services underwriting, renewals and claims processing. The role involves handling customer requests, processing transactions, and coordinating with multiple departments to resolve cases.

Bilingual English/Spanish abilities are valuable for drafting responses and interacting with diverse clients. Qualifications include an Associate's Degree in Business Administration or Marketing, or equivalent experience with at least 1 year in

Qualifications

• Associate degree or equivalent with relevant work experience in health services/underwriting support.
• Strong communication and problem-solving abilities; bilingual in English and Spanish.
• Experience with handling customer requests and documentation is a plus.

Responsibilities

• Support health services underwriting, renewal and claims processes under supervision.
• Assist customers visiting or calling to handle product requests and policy health coverage.
• Process petitions, payments, maintenance, refunds, claims, letters, activations, cancellations, pharmacy actions and grievances.
• Investigate and resolve customer requests by coordinating with other departments.
• Draft documents in English and Spanish in response to requests when required.

Skills

Customer service

Bilingual EN/ES

Analytical thinking

Education

Associate's Degree in Business Administration or Marketing

Job description

At Triple-S, we are committed to providing meaningful job experiences for Valuable People (Gente Valiosa). We strive for excellence in everything we do, from the way we work together to the way we serve our customers.

When you join Triple-S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our purpose to enable healthier lives. We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses.

Job Summary

Independently performs non-routine tasks in support of health services underwriting, renewal and claims processes applying various operational procedures and guidelines under general supervision. It can act as a trainer and involves the use of judgment to perform analysis and evaluation of requests to determine and execute the appropriate action.

Essential Functions

• Support, assist and guide customers who visit or call to handle their product requests health coverage and other policies.
• Processes required petitions to complete the transaction requested by the client such as payments, maintenance, subscriptions, refunds, claims, letters, certificates, activations, cancellations, pharmacy, and complaints and grievances.
• Analyzes and investigates customer requests and intervenes and works with other departments and divisions of the company to achieve the resolution of the case.
• Evaluates and determines the action to take regarding the client's requests, according to the applicable laws.
• Research and draft documents in English and Spanish answering requests if required.
• Assists the Supervisor, Manager, Director in meetings, preparation of reports, audits or any other item, as necessary.

EDUCATION

• Associate's Degree in Business Administration or Marketing

Experience

• Associate Degree in Business Administration, Marketing or Communications or at least 60 university or college credits, with one year of experience related to configuration processes, preferred.
• Or instead, High School Diploma with a minimum of 3 years of experience related to configuration processes, preferably.

LICENSES AND CERTIFICATIONS

• None required

COMPETENCIES

• Action Oriented
• Collaborates
• Instills Trust
• Manages Ambiguity
• Customer Delight (Employee)

It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, sex, gender identity, real or perceived sexual orientation, civil status, social condition, political ideologies, age, physical or mental disability, veteran status or any other characteristic protected by law. Drug-free company.

Equality Employment Opportunity/Affirmative Action for People with Disabilities/Veterans. Employer with E-Verify to verify the eligibility of employment of all the new employees.

We encourage Veterans and Disabled to Apply.