Representante de Servicio I - CS Caguas

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

Job summary

MCS Health seeks a Customer Service Representative I to assist customers and prospects with information about our health products and services. You will address questions from beneficiaries and resolve service needs by following established processes to ensure continuity of offerings by the Service Center.

The role requires a Bachelor's degree or equivalent experience, strong communication in Spanish and English, and familiarity with CRM tools.

Qualifications

• Education: Bachelor’s degree or two years of college credits with related experience in customer service, preferably in health insurance.
• Alternative: An Associate degree with one year of customer service experience.
• Alternative: High School diploma with two years of customer service experience in health insurance.

Responsibilities

• Handle and resolve service requests from customers and prospects, including inquiries about eligibility, policy changes, duplicate cards, and reimbursements.
• Prepare coverage certifications and non-covered service letters as requested.
• Maintain accurate policyholder data in the systems and update demographics.
• Log and track cases in the CRM, provide status updates, and document service steps.

Skills

Customer service

Call center

Keyboard etiquette

Phone etiquette

Spanish language

English language

Education

Bachelor's degree

Associate degree

High School Diploma

Tools

CRM system

Job description

The Customer Service Representative I C C 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 policyholders 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.
• 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: Bachelors 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 Associates 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)

MCS Healthcare Holdings, LLC. (MCS) is an Equal Employment Opportunity Employer and take Affirmative Action to recruit Protected Veterans and Individuals with Disabilities. MCS is a participating E-Verify employer.