Customer Service Representative I - SC Caguas

MCS Puerto Rico; Caguas (PR); On-site; USD 28,000 - 36,000; Full time

Job summary

MCS Puerto Rico is seeking a Customer Service Representative I – SC to assist customers with information about health products and services. You will resolve routine needs by following established processes and documenting interactions to ensure continuity of offerings by the Service Center.

The role requires handling inquiries on policyholder eligibility, benefits, and claims, updating demographics, logging cases in the CRM, and coordinating with other departments to support customer retention.

Qualifications

• Bachelor’s degree, or equivalent education, required.
• 1 year of experience in customer service, preferably health insurance call center.
• 60–64 college credits / Associate’s degree with 1 year of health insurance customer service preferred.
• High school diploma with 2 years of customer service experience preferred.

Responsibilities

• Handle and resolve service requests from customers, including inquiries about policyholders and dependents.
• Prepare coverage certifications and letters of non-covered services.
• Maintain updated policyholder demographics in systems.
• Log cases in CRM, inform customers of status, and document steps taken.
• Answer calls from Call Center and ensure follow-up when needed.
• Refer complaints to the appropriate unit and support other departments as required.

Skills

Customer service

Phone etiquette

Keyboarding

Education

Bachelor’s degree

60–64 college credits / Associate’s degree

High school diploma

Tools

CRM systems

Job description

GENERAL DESCRIPTION

The Customer Service Representative I – SC is responsible for assisting customers and prospects 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.

The Customer Service Representative I – SC is responsible for assisting customers and prospects 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.
• 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 to sixty-four (60-64) college credits, equivalent to two (2) years of study or an Associate’s Degree. At least one (1) year of experience working in Customer Service areas, preferably 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, preferably in a Call Center in the Health Insurance Industry.

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

Certifications / Licenses

N/A

Other

Customer Service oriented, keyboard and telephone etiquette knowledge.

Languages

• Spanish – Intermediate (comprehensive, writing and verbal)
• English – Intermediate (comprehensive, writing and verbal)