CarePlus Call Center Rep - Puerto Rico

Humana • Puerto Rico, TX

4d • Remote

About The Position

The CarePlus Medicare Call Center Representative 2 represents the company by addressing incoming telephone, digital, or written inquiries from Medicare members. The CarePlus Medicare Call Center Rep performs varied activities and moderately complex administrative / operational / customer support assignments. Performs computations. Typically works on semi-routine assignments. In this position, you will strive to provide our CarePlus Medicare members with a resolution or pathway to resolution on each call, while providing a perfect call experience. Among other responsibilities, you will address member needs which may include complex benefits questions, resolving issues, and educating our members. You will handle 20 to 35 inbound calls daily from Medicare members with a focus on high-quality service and one-call resolution. This is a high-volume call center setting, which may be stressful at times. As a CarePlus Medicare Call Center Rep, you will receive inbound calls; 60% to 70% of them require you to place outbound calls to physicians, DME vendors, pharmacies or other entities to help members. You will accurately record details of inquiries, comments or complaints, transactions, or interactions, and take appropriate action accordingly. Decisions are typically focused on interpretation of area / department policy and methods for completing assignments. You will be responsible for escalating unresolved and pending customer grievances. You will work under minimal direction within defined parameters to identify work expectations and quality standards but will have some latitude over prioritization / timing. You will follow standard policies / practices that allow for some opportunity for interpretation / deviation and / or independent discretion. Requires strong emotional intelligence to proactively provide solutions, ensuring the member's utmost health and safety. Use your skills to make an impact.

Requirements

• Must currently live in the Commonwealth of Puerto Rico.
• Must be fully Bilingual in English / Spanish with the ability to speak, read, and write in both languages without limitations or assistance.
• 1+ years of customer service experience.
• Demonstrated experience with providing strong customer service, using effective communications skills and strong attention to detail while also actively listening to their needs.
• Prior experience managing multiple or competing priorities, including use of multiple computer applications / systems simultaneously.
• Proficient with Microsoft Office applications, particularly Outlook and Teams.
• Ability to maintain a professional demeanor, practicing strict confidentiality for all sensitive information.
• Must take strong initiative with the ability to adapt to change quickly and be empathetic.
• Must be willing to remain in this position for a period of twelve (12) months before applying to other Humana opportunities.
• Self-provided internet service must meet the following criteria: ability to provide a high-speed DSL or cable modem for a home office. A download speed of 25 Mbps and an upload speed of 10 Mbps is required.
• Must be hard-wired to their internet connection. Wireless, satellite, cellular, and microwave connections are NOT permitted.
• Must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Nice To Haves

• Associate or Bachelor’s degree
• Previous call center or related customer service experience
• Previous experience with case management processes
• Previous healthcare experience

Responsibilities

• Address incoming telephone, digital, or written inquiries from Medicare members.
• Provide members with a resolution or pathway to resolution on each call, while providing a perfect call experience.
• Address member needs which may include complex benefits questions, resolving issues, and educating members.
• Handle 20 to 35 inbound calls daily from Medicare members with a focus on high-quality service and one-call resolution.
• Receive inbound calls; 60% to 70% of them require placing outbound calls to physicians, DME vendors, pharmacies or other entities to help members.
• Accurately record details of inquiries, comments or complaints, transactions, or interactions, and take appropriate action accordingly.
• Escalate unresolved and pending customer grievances.
• Work under minimal direction within defined parameters to identify work expectations and quality standards.
• Follow standard policies / practices that allow for some opportunity for interpretation / deviation and / or independent discretion.
• Proactively provide solutions, ensuring the member's utmost health and safety.

Benefits

• Medical benefits
• Dental benefits
• Vision benefits
• 401(k) retirement savings plan
• Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
• Short-term disability
• Long-term disability
• Life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree