Customer Service Representative

Triple-S Management Corp.; Northern (KY); On-site; USD 55,000 - 65,000; Full time

Job summary

Triple-S Management Corp. is seeking a detail‑oriented professional to support health services underwriting, renewal and claims, handling non‑routine tasks under supervision.

The role may involve training others and using sound judgment to analyze requests and determine appropriate actions. The incumbent will assist customers with health coverage and policy requests, draft bilingual documents in English and Spanish, and collaborate across departments to resolve cases, while aligning with

Qualifications

• Associates degree required or higher.
• Ability to interpret policies and procedures.
• Bilingual documentation may be required.

Responsibilities

• 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.

Skills

Action Oriented

Manages Ambiguity

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, 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


• Manages Ambiguity

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.