Customer Service Representative

Triple-S Management Corp.; San Juan (PR); Hybrid; USD 36,000 - 56,000; Full time

Job summary

Triple-S Management Corp. in Puerto Rico is seeking a health services underwriting support professional to perform non-routine tasks under supervision, assisting with health service underwriting, renewal and claims processes.

You will apply various procedures and guidelines and may train others as needed. Responsibilities include handling product requests, coordinating with other departments, drafting documents in English and Spanish, and supporting audits and reports.

Qualifications

• Associate's Degree in Business Administration or Marketing.
• Experience: 1 year of experience related to configuration processes, preferred.
• Alternatively, High School Diploma with at least 3 years of experience in configuration processes.

Responsibilities

• Supports and guides customers who visit or call to handle product requests for health coverage and other policies.
• Processes required petitions to complete transactions such as payments, maintenance, subscriptions, refunds, claims, letters, certifications, activations, cancellations, pharmacy, and grievances.
• Analyzes and investigates customer requests, coordinating with other departments to resolve cases.
• Evaluates and determines actions to take on client requests according to applicable laws.
• Researches and drafts documents in English and Spanish when required.
• Assists Supervisor/Manager/Director in meetings, report preparation, audits or related tasks.

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.