Health Insurance Member Support Specialist

TPIS; Puerto Rico; On-site; USD 14,000 - 19,000; Full time

Job summary

TPIS is seeking a Customer Service Representative for its Health Insurance operations in Aguada, PR. The on-site role assists customers and prospects with product and service information, answers questions on eligibility, and documents service activity to ensure continuity of offerings by the Service Center.

Responsibilities include handling inquiries, preparing certifications, updating demographics, logging cases in CRM, and supporting retention efforts.

Qualifications

• High School Diploma. At least three (3) years of experience working in Customer Service, preferably in the Health Insurance Industry.
• Computer proficiency

Responsibilities

• Handles and resolves service requests from customers and prospects, including inquiries about eligibility of policyholders and dependents, changes to IPAs and PCPs, issuance of duplicate cards, coverage certifications, value programs, and premium collections.
• Prepares coverage certifications and letters of non-covered services upon request.
• Maintains updated policyholder demographics in systems.
• Registers visitors, evaluates service situations, and adheres to wait times, quality, accuracy and error-rate standards.
• Logs cases in CRM, keeps customers informed, and documents steps to complete the service cycle.
• Handles calls from the Call Center, ensuring follow-up when needed and resolving issues after first contact.
• Refers complaints to the appropriate unit following protocol.
• Receives and channels service requests from other departments to support customer retention.
• Supports Health Risk Assessment (HRA) calls for other departments.

Skills

Computer proficiency

Education

High School Diploma

Job description

TPIS is seeking a Customer Service Representative for its Health Insurance operations in Aguada, PR. The on-site role assists customers and prospects with product and service information, answers questions on eligibility, and documents service activity to ensure continuity of offerings by the Service Center.

Responsibilities include handling inquiries, preparing certifications, updating demographics, logging cases in CRM, and supporting retention efforts.