Customer Service Representative I - Call Center

MCS Puerto Rico; San Juan (PR); On-site; USD 25,000 - 42,000; Full time

Job summary

MCS Healthcare Holdings, LLC. (MCS) is seeking a Customer Service Representative I – CC to provide excellent service to policyholders, members, and providers via phone.

This role focuses on solving service needs, documenting interactions, and ensuring continuity of services through established call center processes. Candidates should have a degree or credits as specified, with health insurance customer service experience preferred, and flexibility to work rotating shifts including weekends and

Qualifications

• Bachelor’s Degree from an accredited institution.
• At least one year of experience in Customer Service, preferably in a Health Insurance Call Center.
• Sixty (60) college credits, equivalent to two years of study, with at least two years in Customer Service in Health Insurance.
• High School Diploma with at least three years of Customer Service in Health Insurance.
• Knowledge of medical billing is preferable; availability to work rotating shifts, weekends, and holidays.

Responsibilities

• Handles all inbound calls to offer quality service and ensure first call resolution.
• Evaluate, solve, and document situations presented by policyholders, members, and providers.
• Channel concerns according to policy and procedures.
• Utilizes the telephone system and adheres to the schedule to maximize call durations.
• Guarantees established quality and service standards in handling all calls.
• Meet KPIs for productivity, assigned itinerary, quality of service, documentation, and interactions.
• Comply with company policies, local and federal laws, and industry regulations.
• May perform other duties as assigned.

Skills

Customer Service

Call Center

Medical Billing

Spanish (Basic)

English (Basic)

Education

Bachelor’s Degree

60 College Credits

High School Diploma

Job description

GENERAL DESCRIPTION:

The Customer Service Representative I – CC is responsible for providing excellent service when answering requests from policyholders, members, and providers through phone calls received. Solves situations or service needs, channeling them through the established operational processes and service guidelines. Documents the service provided to guarantee the continuity of the services offered by the MCS Call Center.

Regular

Non-Exempt

GENERAL DESCRIPTION:

The Customer Service Representative I – CC is responsible for providing excellent service when answering requests from policyholders, members, and providers through phone calls received. Solves situations or service needs, channeling them through the established operational processes and service guidelines. Documents the service provided to guarantee the continuity of the services offered by the MCS Call Center.

ESSENTIAL FUNCTIONS:

• Handles all inbounds calls accordingly to the established call protocol to offer quality service and guarantee a first call resolution.
• Evaluate, solve, and document the situations presented in the call by policyholders, members, and providers.
• Channeling policyholders, member or providers concern’s according to policy and procedures.
• Utilizes the telephone system, aligning with their work schedule to maximize call durations, ensuring the Call Center's performance metrics.
• Guarantees the established quality and service standards are met in the handling of all received calls.
• To achieve compliance with established key performance indicators (KPIs), it is essential that productivity, assigned itinerary, quality of service, documentation of each service, handling of calls, addressing of customer and provider inquiries, and interactions with customers and providers all meet the predetermined percentages and adhere to approved protocols while maintaining a respectful and cordial demeanor.
• Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
• May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.

MINIMUM QUALIFICATIONS:

Education and Experience:

Bachelor’s Degree from an accredited institution. At least one (1) year of experience performing duties in a similar position in Customer Service areas, preferably in a Call Center in the Health Insurance Industry.

OR

Education and Experience:

Sixty (60) college credits, equivalent to two (2) years of study or an associate degree. At least two (2) years of experience working in Customer Service areas, preferably in a Call Center in the Health Insurance Industry.

OR

Education and Experience:

High School Diploma. At least three (3) years of experience working in Customer Service areas, preferably in a Call Center in the Health Insurance Industry.

“Proven experience may be replaced by previously established requirements.”

Certifications / Licenses:

N/A

Other:

Knowledge of medical billing, preferably. Availability to work rotating shifts, Saturdays, Sundays, and holidays, per the operation’s requirements.

Languages:

Spanish – Basic (comprehensive, writing and verbal)

English – Basic (comprehensive, writing and verbal)

Must be available to work Monday through Sunday, between 8:00 a.m. and 8:00 p.m. (7.5 hours shift)

"MCS Healthcare Holdings, LLC. (MCS) is an Equal Employment Opportunity Employer and take Aff…"