Representante de Servicio al Cliente I - CC
GENERAL DESCRIPTION:
Responsible for providing an excellent service when answering requests from policyholders, members, and providers
through phone calls received. Solves situations or service needs, channeling them through the established operational
processes and service guidelines. Documents the service provided to guarantee the continuity of the services offered by
the company Call Center.
ESSENTIAL FUNCTIONS:
- Handles phone calls received from the assigned business line. Answers them following the established call protocol
to offer quality service and guarantee the accuracy of the information provided.
- Evaluate, solve, and document the situations presented in the call by policyholders, members, and providers, making
sure to classify and channel the service request according to the established processes.
- Uses the UIP ASPECT connection system, connecting according to their work schedule, maximizing call time. By
doing so, they can contribute to the Call Center performance metric of answering calls within the first 30 seconds,
without exceeding the abandonment rate and waiting time not exceeding 2 minutes, following the expectations of
the company and regulatory agencies.
- Guarantees that the established quality and service standards are met in the handling of calls received in the unit.
- Works on the established parameter of documentation of the service provided through the call received, including
relevant, concise, and accurate information.
- Maintains their disposition code in the telephone system, guaranteeing compliance with the established parameters.
- Makes coverage certifications, if necessary, and letters of non-covered services, among others, as requested by the
policyholder, member, and provider.
- Maintains updated demographic information of policyholder members in the Power MHS and Voyager databases,
among others.
- Requests card duplicates and other service requests, such as changes in PCP (Primary Care Physician) in case of
assigned line of business and premium payments, among others.
- Receives, guides, and documents concerns received from policyholders, members, and/or providers. Refers to the
corresponding units the complaints received from policyholders, members, or providers according to the
established protocol and the stipulated time.
- 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.
- May perform other duties and responsibilities as assigned in accordance with the education and experience
requirements contained in this document.
MINIMUM QUALIFICATIONS
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.
OR
Sixty (60) college credits, equivalent to two (2) years of study or an associate degree. At least two (2) years of experience working in Customer Service areas, preferably in a Call Center in the Health Insurance Industry.
OR
Bachelor’s degree from an accredited institution. At least one (1) year of experience performing duties in a similar position 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, preferably. Availability to work rotating shifts, Saturdays, Sundays, and holidays.
Languages:
Spanish - Basic (writing, conversational, and comprehension)
English - Basic (writing, conversational, and comprehension)
“Somos un patrono con igualdad de oportunidad en el empleo y tomamos Acción Afirmativa para reclutar a Mujeres, Minorías, Veteranos Protegidos y Personas con Impedimento”