Provider Service Specialist — HIPAA & Benefits

MCS Health; San Juan (PR); In loco; USD 32.000 - 42.000; Tempo pieno

Descrizione del lavoro

MCS Health is seeking a Customer Service professional to answer and make provider and member inquiries in a health insurance call center. You will document, investigate, and resolve complex questions about benefits, eligibility, COB, and provider configurations while maintaining HIPAA compliance.

The role supports primary care physicians and hospitals, requires rotating shifts including weekends/holidays, and emphasizes first-call resolution, accuracy, and customer service excellence.

Competenze

• Bachelor’s degree from an accredited institution.
• At least six (6) months of experience performing duties in a Customer Service area, preferably in a Call Center in the Health Insurance Industry.
• Sixty (60) college credits, equivalent to two (2) years of study or an associate degree, with at least one (1) year in Customer Service in Health Insurance.
• High School Diploma with at least two (2) years of Customer Service in Health Insurance.
• Certifications / Licenses: Not required.
• Other: Knowledge of medical billing, availability to work rotating shifts, Saturdays, Sundays, and holidays.
• Languages: Spanish – Intermediate; English – Intermediate.

Mansioni

• Accurately documents, investigates, and facilitates resolution of complex inquiries related to benefits interpretation, provider configurations, claim edits, eligibility determinations, and COB.
• Serves as the primary contact for provider-related service inquiries and issues within MCS Classicare and MCS Life Networks.
• Ensures HIPAA compliance and data privacy in all interactions and system usage.
• Educates providers on use of provider platform tools, including access recovery and account management.
• Works to meet KPIs: productivity, schedule adherence, call handling, and quality standards.

Conoscenze

Customer Service

Call Center

HIPAA compliance

Medical billing knowledge

Formazione

Bachelor's Degree

60 college credits

High School Diploma

Descrizione del lavoro

MCS Health is seeking a Customer Service professional to answer and make provider and member inquiries in a health insurance call center. You will document, investigate, and resolve complex questions about benefits, eligibility, COB, and provider configurations while maintaining HIPAA compliance.

The role supports primary care physicians and hospitals, requires rotating shifts including weekends/holidays, and emphasizes first-call resolution, accuracy, and customer service excellence.