Customer Service Representative I - SC - Guayama - Temporary

MCS Healthcare Holdings, LLC (MCS)•Guayama, PR

About The Position

The Customer Service Representative I – SC assists customers and prospects with information about the company’s products and services and addresses questions and concerns from beneficiaries. The representative resolves service needs by following established operational processes and service guidelines and documents services provided to maintain continuity of offerings by the Service Center. The role handles requests related to policyholder and dependent eligibility, cancellation letters, IPA and PCP changes, duplicate cards, coverage certifications, beneficiary value programs, utility and premium collections, and reimbursement requests. It also maintains policyholder demographic information, prepares coverage and non-covered-service letters, registers visitors, assesses service situations, and handles cases through the CRM referral tool. Representatives keep customers informed, document service steps, prepare transaction reports, respond to calls about benefits and coverage, refer complaints to the appropriate unit, and support other departments, including by completing Health Risk Assessment calls. The position requires compliance with company policies and procedures, applicable local and federal laws, and industry regulations. Other duties may be assigned according to the role’s education and experience requirements.

Requirements

Bachelor’s degree from an accredited institution and at least six months of experience in a similar customer service position; health insurance Call Center experience is preferred. Alternatively, 60–64 college credits (equivalent to two years of study) or an Associate’s degree and at least one year of customer service experience; health insurance Call Center experience is preferred. Alternatively, a high school diploma and at least two years of customer service experience; health insurance Call Center experience is preferred.
Customer-service orientation.
Knowledge of keyboarding and telephone etiquette.
Intermediate Spanish proficiency in comprehension, writing, and verbal communication.
Intermediate English proficiency in comprehension, writing, and verbal communication.

Nice To Haves

Experience in a Call Center in the Health Insurance Industry.

Responsibilities

Handle and resolve service requests from customers and prospects, including inquiries about eligibility, cancellations, IPA and PCP changes, duplicate cards, coverage certifications, beneficiary programs, collections, and reimbursement requests.
Prepare coverage certifications and letters of non-covered services according to policyholders’ requests.
Maintain current policyholder demographic information in company systems.
Register visitors and evaluate members’ service situations to identify improvement areas and determine appropriate actions while adhering to service standards.
Log cases, work cases received through the CRM case referral tool, keep customers informed of status, and notify them of outcomes.
Document the steps taken to complete service cycles and prepare transaction reports in accordance with documentation requirements.
Handle calls from the company’s Call Center lines of business about complex questions or concerns regarding benefits, processes, and coverage.
Complete follow-up service cycles for calls not resolved at first contact or for which follow-up was promised.
Refer policyholder complaints to the appropriate unit according to established protocol.
Receive, document, resolve, or route service requests from other departments and ensure a response is received.
Support other departments by completing Health Risk Assessment calls.
Comply with company policies and procedures, applicable local and federal laws, and industry regulations.
Perform other duties and responsibilities as assigned.