Customer Service Representative I - CC

MCS Puerto Rico; San Juan (PR); On-site; USD 26,000 - 32,000; Full time

Job summary

MCS Puerto Rico is seeking a dedicated Call Center Customer Service Representative in Puerto Rico. You will handle inbound calls from policyholders, members, and providers, resolving inquiries per standard processes and documenting interactions for compliance and continuity.

Responsibilities include maintaining HIPAA compliance, achieving KPIs, and contributing to continuous improvement while supporting service quality and policy guidelines within the call center environment.

Qualifications

• Bachelor's degree from an accredited institution or 60 college credits with relevant experience.
• At least 6 months of experience in customer service, preferably in a call center in health insurance.
• High school diploma with 2+ years in customer service, preferably in health insurance.

Responsibilities

• Handles inbound calls following established protocols to deliver quality service and resolve inquiries.
• Maintains confidentiality and HIPAA compliance in all customer interactions and data handling.
• Meets KPIs including productivity, schedule adherence, call handling, quality standards, and accurate documentation.
• Participates in initiatives to improve efficiency, productivity and service quality in the call center.

Skills

Customer service

Communication skills

Problem solving

Attention to detail

Bilingual Spanish/English

Education

Bachelor's degree

60 college credits

High school diploma

Job description

General Description

Responsible for providing high-quality customer service to policyholders, members, and providers through inbound calls. Effectively resolves service inquiries in accordance with established operational processes and service guidelines, while accurately documenting all interactions to ensure service continuity and compliance with Call Center standards.

Regular

Non-Exempt

Essential Functions

• Ensures confidentiality, security, and proper handling of customer, member, and provider information by complying with the Health Insurance Portability and Accountability Act (HIPAA) requirements, data privacy policies, and all applicable regulatory and company guidelines during all customer interactions and system usage.
• Handles inbound calls following established call protocols to deliver quality service, achieve first call resolution, and appropriately evaluate, resolve, document, or escalation customer inquiries in accordance with policies and procedures.
• Meets established key performance indicators (KPIs), including productivity, schedule adherence, call handling, quality standards, accurate documentation, and professional customer interactions, in compliance with approved protocols.
• Participates in initiatives as required, supporting efforts to enhance operational efficiency, productivity, and service quality within the Call Center, in alignment with established processes and performance objectives.
• Provides feedback and participates in continuous improvement efforts by identifying service gaps, recurring issues, or process inefficiencies observed during customer interactions.
• Adheres to established operational policies, procedures, scripts, and service guidelines to ensure consistent and compliant service delivery.
• Utilizes the telephone system in accordance with assigned schedules and operational guidelines to support call center performance metrics.

Additional Functions

• 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 six (6) months of experience performing duties in a similar position in Customer Service areas, preferably in a Call Center in the Health Insurance Industry.
• Education and Experience: Sixty (60) college credits, equivalent to two (2) years of study or an associate degree. At least one (1) year of experience working in Customer Service areas, preferable in a Call Center in the Health Insurance Industry.
• Education and Experience: High School Diploma. At least two (2) years of experience working in Customer Service areas, preferable in a Call Center in the Health Insurance Industry.

Proven experience may be replaced by previously established requirements.

Certifications / Licenses: Not required.

Other: Knowledge of medical billing, preferably. Availability to work rotating shifts, Saturdays, Sundays, and holidays, per the operations requirements. Customer Service oriented, keyboard and telephone etiquette knowledge.

Languages

Spanish – Basic (comprehensive, writing and verbal)

English – Basic (comprehensive, writing and verbal)

"Somos un patrono con igualdad de oportunidad en el empleo y tomamos Acción Afirmativa para reclutar a Mujeres, Minorías, Veteranos Protegidos y Personas con Impedimento"