Customer Service Representative

**Job Purpose**

**Main daily responsibilities, but not limited to**:

- Register Policies in the system with proper eligibility, add Members/dependents and create appropriate tasks that will trigger proper workflow
- Documentation of all calls or communications in the Members record (when applicable)
- Confirmation of Benefits and Eligibility information to members and providers.
- Identify medical services that require an authorization from the Corporate Client and take appropriate actions (initiate authorization, provide status on existing ones and escalate any issues to Case Management)
- Coordination of medical services in/outside the USA, this, in most cases, include locating and contacting several Providers who have the availability and suit the Members preferences and accept our Guarantee of Payment for a cashless experience
- Ensure that Providers send claims to the proper address for processing and/or payment and that only the correct amounts are collected from the patient (deductible, co-payments, etc.) Assignment of benefits
- Provide referrals to in network Providers to all Members, Corporate Clients and sometime other Providers, confirmation of participation of a specific Provider in the network. Steer callers to in network facilities/providers to generate higher revenue.
- Provide claims information like status, process date, detailed payment amount, check number, discounts taken, etc. to Members, Corporate Clients and Providers by making the necessary contacts.
- Assist on resolving any billing issue by contacting the appropriate department and/or parties involved.
- Identify balance billing by analyzing claim and payment information available.
- Identify potential problems and take prompt corrective actions in order to avoid escalated issues that require supervisory intervention.
- Keep Account Managers informed of any delicate issue that may require their attention in order to avoid or resolve an existing problem.
- Calm irate Members and Providers and reassure their problems and concerns will be dealt with in an effective and timely manner.
- Make decisions on when a specific issue needs to be brought to the attention of the supervisor/manager.
- Respond and address new business concerns from existing and potential customers.
- Log and record all type communications for patient files.
- Respond to general queries from members (policy procedures, reimbursements, etc.). Redirect callers when necessary
- Follow up until completion on all issues that are not resolved on the initial contact, keep parties updated on steps and actions taken.
- Service the maximum amount of callers in the quickest and most efficient way without sacrificing the quality of the service.

**Requirements**:

- Bilingual (English & Spanish)
- Must be detail-oriented and organized
- Must possess critical thinking skills as well as the ability to manage time efficiently.
- Must be able to gather the information necessary to assist customers.
- Always be sharp and alert.
- Needs to communicate well with co-workers (verbal and written).
- Knowledge of phone manners, etiquette and protocols.
- Professional phone etiquette and written skills
- Ability to adapt to changes
- Able to understand, interpret and explain policies and procedures as well as knowledge of commonly used concepts, practices and procedures in the field.
- Ability to deal with irate customers and complaints while maintaining composure and control of the situation.
- Knowledge of Microsoft Office.
- Ability to learn from past experiences.

Tipo de puesto: Tiempo completo, Por tiempo indeterminado

Sueldo: $16,000.00 - $16,131.00 al mes

Beneficios:

- Programa de referidos
- Seguro de gastos médicos
- Seguro de gastos médicos mayores
- Seguro dental
- Seguro de vida
- Vacaciones adicionales o permisos con goce de sueldo

Tipo de jornada:

- Incluye días feriados
- Lunes a viernes
- Turno de 8 horas
- Turno matutino

Idioma:

- Inglés (Obligatorio)

Lugar de trabajo: Empleo presencial

Fecha de inicio prevista: 03/10/2025