Representante De Servicio I - CS - Caguas

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

Job summary

MCS Healthcare Holdings, LLC is seeking a Customer Service Representative I – SC to assist customers and prospects with information about products and services. You will resolve service needs following established processes and document actions to ensure continuity of offerings by the Service Center.

The role involves handling inquiries about policyholder eligibility, changes to IPAs/PCPs, duplicate cards, and reimbursements, while maintaining CRM case history and providing follow-up as needed.

Qualifications

• Bachelor’s Degree or 60–64 college credits or a high school diploma with relevant call center experience.
• Experience in customer service, preferably in health insurance.
• Proven ability to manage inquiries and document interactions in a system.

Responsibilities

• Handle and resolve service requests from customers and prospects.
• Prepare coverage certifications and letters of non-covered services.
• Maintain and update policyholder demographics in the system.

Skills

Customer service

Call center

Health insurance

CRM software

Education

Bachelor's degree

Associate degree

High school diploma

Tools

CRM software

Job description

Regular

Non-Exempt

GENERAL DESCRIPTION

The Customer Service Representative I – SC is responsible for assisting customers and prospects with information about the company’s products and services. They address and clarify any questions from beneficiaries who have concerns. Resolves service needs by following established operational processes and service guidelines and documents the services provided to ensure the continuity of offerings by the Service Center.

ESSENTIAL FUNCTIONS

• Handles and resolves service requests from customers and prospects, including inquiries about the eligibility of policyholders and dependents, cancellation letters, changes to Independent Practice Associations (IPAs) and Primary Care Physicians (PCPs), issuance of duplicate cards, coverage certifications, beneficiary value programs, utility collections, premium collections, and reimbursement requests, among others.
• Prepares coverage certifications and letters of non-covered services, among others, according to the policyholder’s request.
• Maintains updated the database regarding policyholder demographics information in the systems.
• Registers visitors in the system and evaluates each member’s service situation before interaction to identify areas that need improvement and to determine the appropriate course of action, adhering to established standards such as wait times, service quality, transaction accuracy, and error rates.
• Logs cases in the system or applications, works the cases received through the Customer Relationship Management (CRM) case referral tool, keeps customers informed of the status, and notifies them of the outcome of the request. Documents in the system the steps taken to complete the service cycle, complying with documentation parameters and preparing transaction reports.
• Handles calls from the Call Center of the company’s different lines of business received from members who have questions, concerns, or discomfort about complex situations regarding benefits, processes, and coverage, among others. Ensures that any service cycle is completed for calls that could not be resolved during the first contact or for which there was a commitment to follow up with the customer.
• Refers to the corresponding unit the complaints received from policyholders, following the established protocol.
• Receives, documents, solves, and/or channels service requests from other departments to support customer retention, ensuring a response is received.
• Support other departments by completing Health Risk Assessment (HRA) calls.

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 to sixty-four (60-64) college credits, equivalent to two (2) years of study or an Associate’s 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: N/A

Other: Customer Service oriented, keyboard and telephone etiquette knowledge.

Languages

Spanish – Intermediate (comprehensive, writing and verbal)

English – Intermediate (comprehensive, writing and verbal)

“We are an Equal Employment Opportunity Employer and take Aff… ”

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