Customer Service Representative - Health Insurance Industry

TPIS; Isabela (PR); On-site; USD 14,000 - 19,000; Full time

Job summary

TPIS in Aguadilla, PR is hiring a Customer Service Representative to assist customers on-site with health insurance information, answer questions, and document service activities. The role involves processing coverage changes, eligibility inquiries, and credentialing steps for policyholders and dependents, while maintaining accurate records in the CRM.

The ideal candidate has a High School Diploma and at least three years of customer service experience, plus solid computer skills.

Qualifications

• High School Diploma required.
• At least three years of experience in Customer Service.
• Computer proficiency required.

Responsibilities

• Handles and resolves service requests from customers and prospects, including inquiries about eligibility and coverage.
• Maintains updated customer demographics in the system.
• Logs cases and informs customers of case outcomes and next steps.
• Answers calls from the Call Center and ensures follow-up for unresolved issues.
• Registers visitors, assesses service needs, and documents actions taken.
• Supports other departments with Health Risk Assessment (HRA) calls.

Skills

Customer service

Computer proficiency

Education

High School Diploma

Job description

Customer Service Representative - Health Insurance Industry

FULL TIME Aguadilla, PR, PR

J OB DESCRIPTION

The Customer Service Representative is responsible for assisting customers and prospects on-site with information about the company's products and services. They address and clarify any questions from beneficiaries who have concerns. Resolves service needs by following established operational processes and service guidelines and documents the services provided to ensure the continuity of offerings by the Service Center.

ESSENTIAL FUNCTIONS :

• Handles and resolves service requests from customers and prospects, including inquiries about the eligibility of policyholders and dependents, cancellation letters, changes to Independent Practice Associations (IPAs) and Primary Care Physicians (PCPs), issuance of duplicate cards, coverage certifications, beneficiary value programs, utility collections, premium collections, and reimbursement requests, among others.
• Prepares coverage certifications and letters of non-covered services, among others, according to the policyholder’s request.
• Maintains updated the database regarding policyholder demographics information in the systems.
• Registers visitors in the system and evaluates each member's service situation before interaction to identify areas that need improvement and to determine the appropriate course of action, adhering to established standards such as wait times, service quality, transaction accuracy, and error rates.
• Logs cases in the system or applications, works the cases received through the Customer Relationship Management (CRM) case referral tool, keeps customers informed of the status, and notifies them of the outcome of the request. Documents in the system the steps taken to complete the service cycle complying with documentation parameters and preparing transaction reports.
• Handles calls from the Call Center of the company's different lines of business received from members who have questions, concerns, or discomfort about complex situations regarding benefits, processes, and coverage, among others. Ensures that any service cycle is completed for calls that could not be resolved during the first contact or for which there was a commitment to follow up with the customer.
• Refers to the corresponding unit the complaints received from policyholders, following the established protocol.
• Receives, documents, solves, and/or channels service requests from other departments to support customer retention, ensuring a response is received.
• Support other departments by completing Health Risk Assessment (HRA) calls.

JOB REQUIREMENTS :

• High School Diploma. At least three (3) years of experience working in Customer Service, preferably in the Health Insurance Industry.
• Computer proficiency
• No vacations schedules until March 2027

SCHEDULE:

• Monday to Friday from 8:00am - 4:30pm, Saturdays from 8:00am - 1:00pm (when necessary)
• Availability to work extended hours, weekends, holidays when the operations require it.

COMPENSATION:

• $12.00rph
• Full-time opportunity

TPIS is an Equal Opportunity Employer (EEO Employer / Affineitive Action for Females / Disabled / Veterans). We comply with all Federal, State and Local laws regarding nondiscrimination.