Customer Service Representative Outbound

MCS Puerto Rico; San Juan (PR); On-site; USD 33,000 - 42,000; Full time

Job summary

MCS Puerto Rico is seeking a customer service representative to guide and orient Medicare and MCS Life product members. The role involves conducting satisfaction surveys, regulated calls, and ensuring CMS compliance in a non-exempt, regular-capacity environment.

The position requires education options from Bachelor’s to high school diploma with health insurance call center experience and weekend/holiday availability. Spanish and English proficiency are expected.

Qualifications

• Bachelor’s Degree from an accredited institution or equivalent by credits.
• 60–64 approved college credits, equivalent to two years of study, plus at least one year in customer service in health insurance.
• High School Diploma with at least two years in customer service in health insurance.
• Proven experience may be replaced by previously established requirements.
• Certifications/Licenses: N/A
• Availability to work weekends and holidays as operations require.
• Languages: Spanish – Intermediate; English – Intermediate.

Responsibilities

• Performs outbound calls for various initiatives within campaigns, ensuring quality and service standards.
• Follows telephone protocols using scripts to provide warm, genuine conversations.
• Updates databases and applications per processes while complying with requirements.
• Uses all applications and tools to support call center operations.
• Cross-trains with other teams and participates in related projects.
• Provides orientation on benefits and resolves member questions, escalating when needed.

Skills

Customer service

Call center

Data entry

Team collaboration

Education

Bachelor's degree

60–64 college credits

High school diploma

Tools

CRM software

Database systems

Job description

GENERAL DESCRIPTION: Responsible for providing guidance and orientation to individuals or members of Medicare and MCS Life products. This includes conducting satisfaction surveys and regulated calls while ensuring compliance with quality, experience, and service standards set by the company and the Centers for Medicare and Medicaid Services (CMS) regulations.

Regular

Non-Exempt

GENERAL DESCRIPTION: Responsible for providing guidance and orientation to individuals or members of Medicare and MCS Life products. This includes conducting satisfaction surveys and regulated calls while ensuring compliance with quality, experience, and service standards set by the company and the Centers for Medicare and Medicaid Services (CMS) regulations.

ESSENTIAL FUNCTIONS

• Performs outbound calls for various initiatives within established campaigns, adhering to quality and service standards. Provides prompt attention and an excellent experience characterized by respect, courtesy, and efficiency to fulfill the purpose of the call and resolve any issues that may arise.
• Follows telephone protocols on each call, using authorized scripts while transforming the content into a warm and genuine conversation. This approach aims to provide accurate guidance, positively influencing customer satisfaction and contributing to a stronger service experience. Asks key questions to gather necessary information when reporting and documenting results.
• Accurately updates databases and applications according to established processes for each contacted customer, ensuring compliance with campaign requirements and training provided.
• Utilizes all applications and technological resources effectively to facilitate the Representatives' processes.
• Collaborates with other Call Centers as needed (cross-training) and participates in any additional projects that arise within the same unit or department.
• Provides comprehensive orientation on benefits, clarifying any doubts for members who are dissatisfied with the service. Offers alternatives and escalates issues when necessary.
• 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.

OR

Education and Experience: Sixty to sixty-four (60-64) approved 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.

OR

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: Availability to work weekends and holidays, as per the operations requires, either for training or operational support.

Languages:

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

"MCS Healthcare Holdings, LLC. (MCS) is an Equal Employment Opportunity Employer and take Affirmative Action to recruit Protected Veterans and Individuals with Disabilities. MCS is a participating E-Verify employer."