Customer Service Representative - CR

GENERAL DESCRIPTION: Responsible for resolving service cases received from various sources, including email, voicemail, fax, and internal referrals, that are processed according to established operational procedures and service guidelines to ensure the continuity of services offered by Customer Service. Handles phone calls from members of the Classicare business line. Provides comprehensive benefit guidance to clarify any questions Classicare beneficiaries may have, especially in complex situations related to the beneficiary services. ESSENTIAL FUNCTIONS: •Receives, analyzes, and evaluates cases that must be referred to other units with detailed information and analysis, following established protocol. •Keeps the customer informed throughout the service cycle, including status updates, notifications of outcomes, coordination with support departments, follow-ups, and full documentation in the system. •Contacts beneficiaries with unfavorable satisfaction trends to assess issues and ensure service recovery and improved experience. •Collaborates with other departments to ensure timely dispatch of beneficiary value programs and processing of over the counter (OTC) and/or Te Paga cards returned by mail. •Processes received cases using various referral methods, including the case referral tool, internal referrals from other departments, voicemail messages, fax, website, and social media. •Supports the Commercial line of business by handling cases received via the system. •Conducts outbound calls for established processes, ensuring quality standards and resolving issues during interactions. •Make outbound calls to close the service cycle and update demographic information when necessary. •Utilizes Automatic Call Distributor (ACD) states accurately, ensuring availability and handling, resolving, and documenting customer calls. •Conducts availability tests of teletypewriter (TTY) lines, maintains records, and reports any issues that could affect application operation and line availability when a call is received, providing accurate information to the customer. • Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as 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. At least six (6) months of experience handling inbound and outbound calls and resolving customer inquiries and issues, or performing similar duties in Customer Service environments, preferably within a call center in the Healthcare Insurance industry. OR Education and Experience: Sixty (60) college credits, equivalent to two (2) years of study or an Associate’s Degree. At least one (1) year of experience handling inbound and outbound calls and resolving customer inquiries and issues, or performing similar duties in Customer Service environments, preferably within a call center in the Healthcare Insurance industry. OR Education and Experience: High School Diploma. At least two (2) years of experience handling inbound and outbound calls and resolving customer inquiries and issues, or performing similar duties in Customer Service environments, preferably within a call center in the Healthcare Insurance industry. “Proven experience may be replaced by previously established requirements.” Certifications / Licenses: N/A Other: Knowledge of Medical Billing is preferred. Availability to work weekends and holidays, as per the operations requires. Languages: Spanish – Intermediate (comprehensive, writing and verbal) English – Intermediate (comprehensive, writing and verbal)