MCS Puerto Rico
Customer Service Representative I - SC Arecibo Temporary
MCS Puerto Rico, Arecibo, Arecibo, us, 00612
General Description
The Customer Service Representative I – SC is responsible for assisting customers and prospects with information about the company's products and services. They address and clarify any questions from beneficiaries who have concerns and resolve service needs by following established operational processes and service guidelines. The representative documents the services provided to ensure the continuity of offerings by the Service Center.
Temporary - AEP
Non-Exempt
Essential Functions
Handles and resolves service requests from customers and prospects, including inquiries about the eligibility of policyholders and dependents, cancellation letters, changes to Independent Practice Associations (IPAs) and Primary Care Physicians (PCPs), issuance of duplicate cards, coverage certifications, beneficiary value programs, utility collections, premium collections, and reimbursement requests, among others.
Prepares coverage certifications and letters of non-covered services, among others, according to the policyholder’s request.
Maintains an updated database regarding policyholder demographics information in the systems.
Registers visitors in the system and evaluates each member's service situation before interaction to identify areas that need improvement and to determine the appropriate course of action, adhering to established standards such as wait times, service quality, transaction accuracy, and error rates.
Logs cases in the system or applications, works the cases received through the Customer Relationship Management (CRM) case referral tool, keeps;
/ customers informed of the status, and notifies them of the outcome of the request. Documents in the system the steps taken to complete the service cycle complying with documentation parameters and preparing transaction reports.
Handles calls from the Call Center of the company's different lines of business received from members who have questions, concerns, or discomfort about complex situations regarding benefits, processes, and coverage, among others. Ensures that any service cycle is completed for calls that could not be resolved during the first contact or for which there was a commitment to follow up with the customer.
Refers complaints received from policyholders to the corresponding unit, following the established protocol.
Receives, documents, solves, and/or channels service requests from other departments to support customer retention, ensuring a response is received.
Supports other departments by completing Health Risk Assessment (HRA) calls.
Must comply fully and consistently with all company policies and procedures, with local and federal laws, and 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 with at least one (1) year of experience in a similar position in Customer Service, preferably in a Call Center in the Health Insurance Industry.
Education and Experience:
Sixty (60) college credits, equivalent to two (2) years of study, or an Associate’s Degree with at least two (2) years of experience in Customer Service, preferably in a Call Center in the Health Insurance Industry.
Education and Experience:
Certifications / Licenses:
N/A
Other:
Languages:
Spanish – Intermediate (comprehensive, writing and verbal); English – Intermediate (comprehensive, writing and verbal).
MCS Healthcare Holdings, LLC. (MCS) is an Equal Employment Opportunity Employer and takes affirmative action to recruit Protected Veterans and Individuals with Disabilities. MCS is a participating E-Verify employer.
Employment Type Temporal
Function Otro
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Temporary - AEP
Non-Exempt
Essential Functions
Handles and resolves service requests from customers and prospects, including inquiries about the eligibility of policyholders and dependents, cancellation letters, changes to Independent Practice Associations (IPAs) and Primary Care Physicians (PCPs), issuance of duplicate cards, coverage certifications, beneficiary value programs, utility collections, premium collections, and reimbursement requests, among others.
Prepares coverage certifications and letters of non-covered services, among others, according to the policyholder’s request.
Maintains an updated database regarding policyholder demographics information in the systems.
Registers visitors in the system and evaluates each member's service situation before interaction to identify areas that need improvement and to determine the appropriate course of action, adhering to established standards such as wait times, service quality, transaction accuracy, and error rates.
Logs cases in the system or applications, works the cases received through the Customer Relationship Management (CRM) case referral tool, keeps;
/ customers informed of the status, and notifies them of the outcome of the request. Documents in the system the steps taken to complete the service cycle complying with documentation parameters and preparing transaction reports.
Handles calls from the Call Center of the company's different lines of business received from members who have questions, concerns, or discomfort about complex situations regarding benefits, processes, and coverage, among others. Ensures that any service cycle is completed for calls that could not be resolved during the first contact or for which there was a commitment to follow up with the customer.
Refers complaints received from policyholders to the corresponding unit, following the established protocol.
Receives, documents, solves, and/or channels service requests from other departments to support customer retention, ensuring a response is received.
Supports other departments by completing Health Risk Assessment (HRA) calls.
Must comply fully and consistently with all company policies and procedures, with local and federal laws, and 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 with at least one (1) year of experience in a similar position in Customer Service, preferably in a Call Center in the Health Insurance Industry.
Education and Experience:
Sixty (60) college credits, equivalent to two (2) years of study, or an Associate’s Degree with at least two (2) years of experience in Customer Service, preferably in a Call Center in the Health Insurance Industry.
Education and Experience:
Certifications / Licenses:
N/A
Other:
Languages:
Spanish – Intermediate (comprehensive, writing and verbal); English – Intermediate (comprehensive, writing and verbal).
MCS Healthcare Holdings, LLC. (MCS) is an Equal Employment Opportunity Employer and takes affirmative action to recruit Protected Veterans and Individuals with Disabilities. MCS is a participating E-Verify employer.
Employment Type Temporal
Function Otro
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