Representante de Servicio al Cliente I - CC

Mcs-Healthcare-Holdings,-LLC; San Juan (PR); On-site; USD 17,000 - 22,000; Full time

Job summary

Representante de Servicio al Cliente I - CC en MCS Healthcare Holdings, LLC. Brindar servicio de calidad a asegurados, miembros y proveedores mediante llamadas entrantes, documentando cada interacción para asegurar continuidad y cumplimiento.

Se busca experiencia en servicio al cliente en call center de salud, con disponibilidad para turnos rotativos y conocimientos básicos de facturación médica. Se valorará dominio básico de inglés y español.

Qualifications

• Education and experience as specified: Bachelor's degree with 6+ meses de experiencia en Call Center de salud, o 60 créditos con 1 año de experiencia, o diploma de secundaria con 2+ años de experiencia.
• Conocimientos de facturación médica son deseables.
• Disponibilidad para turns rotativos, fines de semana y días festivos.

Responsibilities

• Asistir a pólizas, miembros y proveedores por teléfono con cortesía y precisión.
• Resolver consultas de servicio siguiendo procesos y guías establecidos.
• Documentar interacciones para continuidad y cumplimiento.
• Alcanzar KPIs de productividad, adherencia y calidad.
• Proporcionar retroalimentación para mejoras de servicio.
• Cumplir políticas, guiones y pautas de servicio.
• Utilizar el sistema telefónico según horarios asignados.

Skills

Customer service

Call center experience

HIPAA compliance

Data entry

Telephone etiquette

Education

Bachelor’s Degree

60 college credits

High School Diploma

Job description

Representante de Servicio al Cliente I - CC

Representante de Servicio al Cliente I - CC

GENERAL DESCRIPTION:

Responsible for providing high-quality customer service to policyholders, members, and providers through inbound calls. Effectively resolves service inquiries in accordance with established operational processes and service guidelines, while accurately documenting all interactions to ensure service continuity and compliance with Call Center standards.

ESSENTIAL FUNCTIONS:

• Ensures confidentiality, security, and proper handling of customer, member, and provider information by complying with the Health Insurance Portability and Accountability Act (HIPAA) requirements, data privacy policies, and all applicable regulatory and company guidelines during all customer interactions and system usage.
• Handles inbound calls following established call protocols to deliver quality service, achieve first call resolution, and appropriately evaluate, resolve, document, or elevate customer inquiries in accordance with policies and procedures.
• Meets established key performance indicators (KPIs), including productivity, schedule adherence, call handling, quality standards, accurate documentation, and professional customer interactions, in compliance with approved protocols.
• Participates in initiatives as required, supporting efforts to enhance operational efficiency, productivity, and service quality within the Call Center, in alignment with established processes and performance objectives.
• Provides feedback and participates in continuous improvement efforts by identifying service gaps, recurring issues, or process inefficiencies observed during customer interactions.
• Adheres to established operational policies, procedures, scripts, and service guidelines to ensure consistent and compliant service delivery.
• Utilizes the telephone system in accordance with assigned schedules and operational guidelines to support call center performance metrics.

ADDITIONAL FUNCTIONS:

• 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 (60) college credits, equivalent to two (2) years of study or an associate 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: Not required.

Other: Knowledge of medical billing, preferably. Availability to work rotating shifts, Saturdays, Sundays, and holidays, per the operation’s requirements. Customer Service oriented, keyboard and telephone etiquette knowledge.

Languages:

Spanish – Basic (comprehensive, writing and verbal)

English – Basic (comprehensive, writing and verbal)

MCS Healthcare Holdings, LLC. (MCS) es un patrono con Igualdad de Oportunidades en el Empleo y tomamos acción afirmativa para reclutar Veteranos Protegidos y Personas con Discapacidad. MCS es un patrono participante de E-Verify.