Provider Services Specialist – Health Insurance

MCS Puerto Rico; San Juan (PR); On-site; USD 38,000 - 52,000; Full time

Job summary

MCS Puerto Rico in San Juan is seeking a customer service professional to answer and make calls for providers and policyholders across the service area and beyond. The role emphasizes resolving issues during the call, maintaining HIPAA compliance, and educating providers on platform tools.

Ideal candidates have a healthcare call center background, strong communication skills in English and Spanish, and flexibility to work rotating shifts including weekends/holidays as required.

Qualifications

• Bachelor's Degree from an accredited institution; at least six months of experience in a customer service role, preferably in a health insurance call center.
• 60 college credits (equivalent to two years) and at least one year of customer service experience, preferably in a health insurance call center.
• High school diploma with at least two years of customer service experience, preferably in a call center within the health insurance industry.

Responsibilities

• Documents, investigates, and facilitates resolution of complex inquiries related to benefits interpretation and COB; coordinates with internal departments for timely resolution.
• Serves as primary point of contact for provider service inquiries for participating and non-participating providers within MCS Classicare and MCS Life Networks.
• Ensures HIPAA compliance and proper handling of sensitive information across all customer interactions and systems.
• Educates providers and staff on provider platform tools, including system access, account creation, and recovery.
• Provides feedback to identify service gaps and contribute to continuous improvement in service quality and performance.
• Participates in initiatives to enhance operational efficiency and productivity in alignment with call center processes.
• Handles inbound calls following established protocols with emphasis on first-call resolution and accurate documentation or escalation.
• Meets KPIs for productivity, schedule adherence, call handling, and quality standards.

Skills

Customer service

Bilingual (Spanish/English)

Education

Bachelor's degree

60 college credits/equivalent to 2 years

High school diploma

Job description

MCS Puerto Rico in San Juan is seeking a customer service professional to answer and make calls for providers and policyholders across the service area and beyond. The role emphasizes resolving issues during the call, maintaining HIPAA compliance, and educating providers on platform tools.

Ideal candidates have a healthcare call center background, strong communication skills in English and Spanish, and flexibility to work rotating shifts including weekends/holidays as required.