Customer Service Representative - CR
MCS HEALTHCARE HOLDINGS, LLC, San Juan, Puerto Rico, United States
Customer Service Representative - CR
Regular Non-Exempt GENERAL DESCRIPTION: Responsible for resolving service cases received from various sources, including email, voicemail, fax, and internal referrals, that are processed according to established operational procedures and service guidelines to ensure the continuity of services offered by Customer Service. Handles phone calls transferred from members of the Classicare business line. Provides comprehensive benefit guidance to clarify any questions Classicare beneficiaries may have, especially in complex situations related to the beneficiary value programs' services. ESSENTIAL FUNCTIONS: Handles inbound calls transferred from the Classicare Call Center that require a more detailed analysis due to the complexity of the topic or instances where the member expresses potential disaffiliation or cancellation to resolve the situation and ensure the member's satisfaction with the services provided. This includes addressing second-level processes, beneficiary value programs, over the counter (OTC) matters, and other related issues. Contacts existing beneficiaries showing trends of unfavorable responses in satisfaction surveys conducted by the plan coverage, aiming to ensure satisfaction with the service. Processes received cases using various referral methods, including the case referral tool, internal referrals from other departments, voicemail messages, fax, website, social media, and pharmacy coverage activations. Keeps the customer informed of the status, notifies of the result of the request to complete the service cycle, refers to support departments as applicable, following up until a response is obtained, and documents all the actions performed in the Customer Relationship Management (CRM) tool to complete the service cycle. Supports the Commercial business line, handling cases received through the case referral tool (CRM). Makes outbound calls to ensure the closure of the service cycle for handled cases and makes modifications related to demographic information, if necessary. Conducts outbound calls for different established campaigns, according to quality standards, offering fast, courteous, and efficient service to resolve issues arising during calls when necessary. Collaborates with other departments to ensure the timely dispatch of beneficiary value programs and the processing of over the counter (OTC) cards returned by mail. Administers the returned beneficiary value program cards effectively, and receives and reconciles mail within established timelines, ensuring proper handling of the beneficiary value program cards. Receives, analyzes, and evaluates cases that must be referred to other units for the corresponding process with detailed information and analysis worked on, following the established protocol. Conducts availability tests of teletypewriter (TTY) lines, maintains records, and reports any issues that could affect application operation and line availability when a call is received, providing accurate information to the customer. Utilizes connection and disconnection states accurately in the Automatic Call Distributor (ACD), ensuring availability to receive transferred calls; additionally, is responsible for contacting the client when the transfer fails. Evaluate, resolve, and document through the calls the situations presented by the insured. 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: Bachelor's Degree from an accredited institution. At least one (1) year 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 (60) college credits, equivalent to two (2) years of study or an Associate's Degree. At least two (2) years 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 three (3) 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: Knowledge of medical billing is preferred. Availability to work weekends and holidays, as per the operations requires, either for training or operational support. Languages: Spanish
Intermediate (comprehensive, writing and verbal) English
Intermediate (comprehensive, writing and verbal) "Somos un patrono con igualdad de oportunidad en el empleo y tomamos Accin Afirmativa para reclutar a Mujeres, Minoras, Veteranos Protegidos y Personas con Impedimento"
Regular Non-Exempt GENERAL DESCRIPTION: Responsible for resolving service cases received from various sources, including email, voicemail, fax, and internal referrals, that are processed according to established operational procedures and service guidelines to ensure the continuity of services offered by Customer Service. Handles phone calls transferred from members of the Classicare business line. Provides comprehensive benefit guidance to clarify any questions Classicare beneficiaries may have, especially in complex situations related to the beneficiary value programs' services. ESSENTIAL FUNCTIONS: Handles inbound calls transferred from the Classicare Call Center that require a more detailed analysis due to the complexity of the topic or instances where the member expresses potential disaffiliation or cancellation to resolve the situation and ensure the member's satisfaction with the services provided. This includes addressing second-level processes, beneficiary value programs, over the counter (OTC) matters, and other related issues. Contacts existing beneficiaries showing trends of unfavorable responses in satisfaction surveys conducted by the plan coverage, aiming to ensure satisfaction with the service. Processes received cases using various referral methods, including the case referral tool, internal referrals from other departments, voicemail messages, fax, website, social media, and pharmacy coverage activations. Keeps the customer informed of the status, notifies of the result of the request to complete the service cycle, refers to support departments as applicable, following up until a response is obtained, and documents all the actions performed in the Customer Relationship Management (CRM) tool to complete the service cycle. Supports the Commercial business line, handling cases received through the case referral tool (CRM). Makes outbound calls to ensure the closure of the service cycle for handled cases and makes modifications related to demographic information, if necessary. Conducts outbound calls for different established campaigns, according to quality standards, offering fast, courteous, and efficient service to resolve issues arising during calls when necessary. Collaborates with other departments to ensure the timely dispatch of beneficiary value programs and the processing of over the counter (OTC) cards returned by mail. Administers the returned beneficiary value program cards effectively, and receives and reconciles mail within established timelines, ensuring proper handling of the beneficiary value program cards. Receives, analyzes, and evaluates cases that must be referred to other units for the corresponding process with detailed information and analysis worked on, following the established protocol. Conducts availability tests of teletypewriter (TTY) lines, maintains records, and reports any issues that could affect application operation and line availability when a call is received, providing accurate information to the customer. Utilizes connection and disconnection states accurately in the Automatic Call Distributor (ACD), ensuring availability to receive transferred calls; additionally, is responsible for contacting the client when the transfer fails. Evaluate, resolve, and document through the calls the situations presented by the insured. 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: Bachelor's Degree from an accredited institution. At least one (1) year 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 (60) college credits, equivalent to two (2) years of study or an Associate's Degree. At least two (2) years 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 three (3) 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: Knowledge of medical billing is preferred. Availability to work weekends and holidays, as per the operations requires, either for training or operational support. Languages: Spanish
Intermediate (comprehensive, writing and verbal) English
Intermediate (comprehensive, writing and verbal) "Somos un patrono con igualdad de oportunidad en el empleo y tomamos Accin Afirmativa para reclutar a Mujeres, Minoras, Veteranos Protegidos y Personas con Impedimento"