Customer Service Representative

Triple-S; Manatí (PR); Hybrid; USD 40,000 - 56,000; Full time

Job summary

Triple-S is seeking a detail-oriented associate to support health services underwriting, renewal, and claims processes. The role involves applying procedures under general supervision and may train others, using sound judgment to analyze requests and take appropriate action.

The position emphasizes bilingual communication in English and Spanish, with duties spanning customer inquiries, payments, refunds, and documentation. A related degree or credits are required.

Qualifications

• Associate's Degree in Business Administration or Marketing; alternatively, 60 college credits with related experience.
• One year of experience related to configuration processes preferred.
• High school diploma plus 3 years of related experience acceptable.

Responsibilities

• Support customers who visit or call to handle product requests and health coverage.
• Process petitions and transactions including payments, cancellations, refunds, and claims.
• Analyze requests and coordinate with other departments to resolve cases.
• Determine actions based on applicable laws and policies.
• Draft documents in English and Spanish when required.

Skills

Customer service

Analytical thinking

Bilingual English/Spanish

Education

Associate's Degree in Business Administration

High School Diploma with 3+ years experience

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. Let's build healthier communities together,

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, certifications, 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.