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 indeterminadoSueldo: $16,000.00 - $16,131.00 al mesBeneficios:- Programa de referidos- Seguro de gastos médicos- Seguro de gastos médicos mayores- Seguro dental- Seguro de vida- Vacaciones adicionales o permisos con goce de sueldoTipo de jornada:- Incluye días feriados- Lunes a viernes- Turno de 8 horas- Turno matutinoIdioma:- Inglés (Obligatorio)Lugar de trabajo: Empleo presencialFecha de inicio prevista: 03/10/2025