Job Description

Job Description

Job Description

Description: The Bilingual Customer Service Representative responsible for providing exceptional service and support to customers our members and providers in both in English and Spanish. Assisting customers with benefit inquiries, claims, eligibility, and provider information, while ensuring a high standard of service and professionalism .

Essential Duties:

• Confers with enrollees by telephone to provide information about services of their respective healthcare insurance plan.
• Provides orientation, support and education services on non-clinical matters related to different plan coverage’s and promotions.
• Manages incoming calls and refer calls to the appropriate resources according to the enrollee specific needs.
• Documents records transactions, recording details of inquiries, as well as actions taken.
• Refers unresolved customer grievances to his/her supervisor or to designated departments for further investigation.
• Provides support to other projects of Contact Center.
• Participates in trainings and development sessions.
• Among other related duties.
• Ensures confidentiality and compliance with all state and federal regulations applicable to Health Call Centers; including HIPAA and internal policy for disposing of confidential information material.
• Notifies any expose of Protected Health Information to the supervisor immediately.
• Complies with medullar & functional trainings; and all procedures established by regulatory agencies, contractual requirements and any applicable certification standards (including but not limited to URAC, among others).

Requirements:

• Academic Degree from accredited institution with a minimum of one (1) year of customer service experience, or High School Diploma with a minimum of three (3) years of customer service experience.
• Must be customer service driven and have strong people skills
• Should demonstrate empathy, sense of urgency, and follow up through to close any unsolved situation.
• Proficient in using computer-based customer service platforms.
• Fully bilingual verbal and written (English and Spanish)
• Available to work fixed schedule (Monday to Friday), holidays and weekends as needed.

What are the benefits of being part of our team as a Service Representative in the Health field?

• Probation Period: 180 days (6 months)

• Leave Entitlements:
  • 15 days of vacation leave
  • 12 days of sick leave
  • Vacation accrues at 10 hours per month
  • Sick leave accrues at 8 hours per month
• Health Insurance: Includes employer contribution
• Retirement Plan: 401(k)
• Training: In-service training covering regulatory aspects and health topics
• Telemedicine Access: 24/7 virtual medical consultations
• Wellness Programs: Employee health and wellness initiatives
• Career Development: Opportunities for growth and professional advancement
• Social Impact: Contribute to the health and well-being of the population
• Paid Leave Benefits: Additional paid leave options available

Job Type: Full-time

Workplace: Onsite in Guaynabo and Mayagüez, PR

EQUAL EMPLOYMENT OPPORTUNITY EMPLOYER - (EEOC)

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