Job Description:
The Bilingual Customer Service Representative is responsible for providing exceptional service and support to customers, members, and providers in both English and Spanish. Assists customers with inquiries related to benefits, claims, eligibility, and provider information, ensuring a high standard of service and professionalism.

Essential Functions:

• Communicates with members by phone to provide information about services covered under their respective health insurance plan.

• Provides guidance, support, and educational services on non-clinical matters related to coverage and promotions of different plans.

• Handles incoming calls and refers them to the appropriate resources based on the member’s specific needs.

• Documents transactions by recording details of inquiries and actions taken.

• Refers unresolved customer complaints to the supervisor or designated departments for further investigation.

• Provides support for other Contact Center projects.

• Participates in training and development sessions.

• Performs other related duties as assigned.

• Ensures confidentiality and compliance with all applicable state and federal regulations for Health Call Centers, including HIPAA, as well as internal policies regarding the handling of confidential information.

• Immediately notifies the supervisor of any exposure of Protected Health Information (PHI).

• Complies with core and functional training requirements, as well as all procedures established by regulatory agencies, contractual requirements, and applicable certification standards (including, but not limited to, URAC).

Requirements:

• Associate’s or bachelor’s degree from an accredited institution with a minimum of one (1) year of customer service experience, or a high school diploma with a minimum of three (3) years of customer service experience.

• Must be customer-service oriented with strong interpersonal skills.

• Must demonstrate empathy, a sense of urgency, and follow-up skills to resolve any outstanding situations.

• Proficiency in the use of computer-based customer service platforms.

• Fully bilingual (English and Spanish), both verbal and written.

• Availability to work a fixed schedule (Monday through Friday), holidays, and weekends as needed.

What are the benefits of joining our team as a Customer Service Representative in the Healthcare area?

• Christmas Bonus, as established by law.

• Health Insurance and Life Insurance.

• 401(k) Retirement Plan.

• Paid leave benefits.

• One (1) personal day.

• One (1) birthday celebration day.

• Training in customer service, regulatory, and healthcare topics.

• 24/7 Telemedicine services.

• Free employee health and wellness programs.

• Opportunities for professional growth and development.

• Contribute to the health and well-being of the population.

Position Type: Full-time / Regular Contract

Work Location: On-site in Guaynabo or Mayagüez, PR

EQUAL EMPLOYMENT OPPORTUNITY EMPLOYER (EEOC)