Representante de Servicio al Cliente I - CC - copy - copy

MCS Health; San Juan (PR); On-site; USD 32,000 - 42,000; Full time

Job summary

MCS Healthcare Holdings, LLC. (MCS) is seeking a Regular, Non-Exempt Customer Service Representative to provide high-quality service to policyholders, members, and providers by phone. You will document interactions and guide requests through established processes, ensuring accurate information and continuity of services.

Responsibilities include handling calls, resolving issues, and maintaining up-to-date demographics in the system, with rotating shifts and adherence to regulatory guidelines.

Qualifications

• Education and Experience: High School Diploma. At least three (3) years of experience working in Customer Service areas, 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. At least two (2) years of experience working in Customer Service areas, preferably in a Call Center in the Health Insurance Industry.
• Bachelor’s degree from an accredited institution. At least one (1) year of experience performing duties in a similar position 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: Knowledge of medical billing, preferably. Availability to work rotating shifts, Saturdays, Sundays, and holidays.

Responsibilities

• Handles phone calls from policyholders, members, and providers, following the call protocol to provide quality service and ensure accurate information.
• Evaluates, resolves, and documents issues, classifying and routing requests per established processes.
• Uses the UIP ASPECT system, connecting according to schedules to maximize call time and meet performance metrics (85% of calls answered within 30 seconds, <=3% abandonment, wait time <=2 minutes).
• Ensures 95% of quality/service standards are met in call handling.
• Adheres to the work schedule to achieve 97% schedule compliance.
• Maintains 98% documentation of the service provided in the telephone system and relevant databases.
• Performs other duties as assigned.

Education

High School Diploma

Associate degree

60 college credits

Bachelor’s degree

Job description

Regular

Non-Exempt

GENERAL DESCRIPTION:

Responsible for providing an excellent service when answering requests from policyholders, members, and providersthrough phone calls received. Solves situations or service needs, channeling them through the established operationalprocesses and service guidelines. Documents the service provided to guarantee the continuity of the services offered bythe MCS Call Center.

ESSENTIAL FUNCTIONS:

• Handles phone calls received from the assigned business line. Answers them following the established call protocol to offer quality service and guarantee the accuracy of the information provided.
• Evaluates, solves, and document the situations presented in the call by policyholders, members, and providers, making sure to classify and channel the service request according to the established processes.
• Uses the UIP ASPECT connection system, connecting according to their work schedule, maximizing call time. By doing so, they can contribute to the Call Center performance metric of answering 85% of calls within the first 30 seconds, without exceeding 3% of abandonment rate and waiting time not exceeding 2 minutes, following the expectations of the company and regulatory agencies.
• Guarantees that 95% of the established quality and service standards are met in the handling of calls received in the unit.
• Complies with the established work schedule to meet 97% of the schedule compliance standard.
• Works on the established parameter of 98% documentation of the service provided through the call received, including relevant, concise, and accurate information.
• Maintains their disposition code in the telephone system, guaranteeing compliance with 98% of the established parameters.
• Makes coverage certifications, if necessary, and letters of non-covered services, among others, as requested by the policyholder, member, and provider.
• Maintains updated demographic information of policyholder members in the Power MHS and Voyager databases, among others.
• Requests card duplicates and other service requests, such as changes in PCP (Primary Care Physician) in case of assigned line of business and premium payments, among others.
• Receives, guides, and documents concerns received from policyholders, members, and/or providers. Refers to the corresponding units the complaints received from policyholders, members, or providers according to the established protocol and the stipulated time.
• Complies fully and consistently with the Company’s standards, policies, and procedures, in conjunction with local and federal laws applicable to our industry, business, and employment practices.
• May perform other duties and responsibilities as assigned in accordance with the education and experience requirements contained in this document.

MINIMUM QUALIFICATIONS

Education and Experience: High School Diploma. At least three (3) years of experience working in Customer Service areas, preferably in a Call Center in the Health Insurance Industry.

OR

Sixty (60) college credits, equivalent to two (2) years of study or an associate degree. At least two (2) years of experience working in Customer Service areas, preferably in a Call Center in the Health Insurance Industry.

OR

Bachelor’s degree from an accredited institution. At least one (1) year of experience performing duties in a similar position 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: Knowledge of medical billing, preferably. Availability to work rotating shifts, Saturdays, Sundays, and holidays.

Languages:

Spanish - Basic (writing, conversational, and comprehension)
English - Basic (writing, conversational, and comprehension)

"MCS Healthcare Holdings, LLC. (MCS) is an Equal Employment Opportunity Employer and take Aff…"

MCS Healthcare Holdings, LLC. (MCS)is an Equal Employment Opportunity Employer and take Aff…