Customer Service Representative - SC Plaza Las Amercias

MCS Healthcare Holdings, LLC (MCS)•San Juan, PR

8d•Onsite

About The Position

Guides customers and prospects on the products and services offered by the company. Provides extended guidance to clarify doubts of beneficiaries who present highly complex situations. Solves situations or service needs, channeling them through the established operational processes and service guides. Documents the service provided to guarantee the continuity of the services offered by the Service Center.

Requirements

Sixty (60) college credits equivalent to two (2) years of study or an Associate’s degree. At least one (1) year of experience in customer service-related work.
OR High school diploma. At least two (2) years of experience in customer service-related work.
“Proven experience may be replaced by previously established requirements.”
Valid driver’s license in the Commonwealth of Puerto Rico.
Availability to work weekends, holidays, and at other Service Centers, as required, either for training or operational needs.
Spanish - Intermediate (writing, conversational, comprehension, and reading)
English - Intermediate (writing, conversational, comprehension, and reading)

Responsibilities

Receives, solves, and/or channels service requests from customers and prospects, such as eligibility of policyholders and dependents, cancellation letters, IPA (Independent Practice Association) & PCP (Primary Care Physician) changes, issuance of card duplicates, Coverage Certification, MCS Te Paga utility collection, premium collection, and receiving and channeling reimbursement requests.
Provides detailed guidance on benefits, clarifying doubts to customers and prospects about products and services.
Meets expected standards, such as waiting time and service, transaction, and transaction error rates.
Analyzes the service situation of each member before attending to them to identify the service situation to be impacted and establish the course of action to be followed.
Records cases in the Q-minder app or other required applications.
Works the cases received through the CRM (Customer Relationship Management) case referral tool. Documents in Gits the internal referrals from other departments and the visits received.
Refers to support departments as applicable, following up until a response is received.
Keeps customers informed of the status and notifies the outcome of the request to complete the service cycle.
Documents in Gits and CRM one hundred percent (100%) of the steps taken to complete the service cycle.
Complies with the established work schedule so that the work agenda and performance standards are not affected.
Complies with the Quality Audit of the Operations Department or other entity authorized by MCS.
Makes daily transaction reports and other reports according to operational needs.
Channels and/or keeps the Supervisor informed of any situations.
Handles calls from the Providers and Classicare Call Center received from members who have questions, concerns, or discomfort about highly complex situations regarding benefits, processes, and coverage, among others.
Receives, solves, and/or channels service requests from the Sales department to support customer retention.
Handles Vision authorization requests from our providers.
Supports the Stars department by completing HRA (Health Risk Assessment) calls.
Responsible for closing the service cycle of calls that are not solved in the first contact and/or there was a commitment with the customer to call back.
Takes part in the preparation of daily transaction reports, registration of visitors in Q-minder, ATH, MCS Te Paga, and registration of refunds, among others.
Performs the duties of the Customer Service Representative position: 1. Evaluates, solves, and documents the situation presented by the policyholder during the visit. 2. Prepares coverage certifications and letters of non-covered services, among others, according to the policyholder’s request. 3. Complies with the established documentation parameter (100%). 4. Keeps up to date the database of the applicable information system regarding the demographic information of the policyholder. 5. Processes card duplicates and other service requests, such as change of primary care physician (PCP), premium payments, and Te Paga utility payments, among others, through the applicable systems. 6. Refers to the corresponding unit the complaints received from policyholders, following the established protocol.
Complies fully and consistently with the Company’s standards, policies, and procedures, in conjunction with local and federal laws applicable to our industry, business, and employment practices.