Customer Service Representative I - Call Center

GENERAL DESCRIPTION: The Customer Service Representative I – CC is responsible for providing 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 MCS Call Center. ESSENTIAL FUNCTIONS: • Handles all inbounds calls accordingly to the established call protocol to offer quality service and guarantee a first call resolution. • Evaluate, solve, and document the situations presented in the call by policyholders, members, and providers. • Channeling policyholders, member or providers concern’s according to policy and procedures. • Utilizes the telephone system, aligning with their work schedule to maximize call durations, ensuring the Call Center's performance metrics. • Guarantees the established quality and service standards are met in the handling of all received calls. • To achieve compliance with established key performance indicators (KPIs), it is essential that productivity, assigned itinerary, quality of service, documentation of each service, handling of calls, addressing of customer and provider inquiries, and interactions with customers and providers all meet the predetermined percentages and adhere to approved protocols while maintaining a respectful and cordial demeanor. • 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 one (1) year of experience performing duties in a similar position in Customer Service areas, preferably in a Call Center in the Health Insurance Industry. OR Education and Experience: 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 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. “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, per the operation’s requirements. Languages: Spanish – Basic (comprehensive, writing and verbal) English – Basic (comprehensive, writing and verbal) Must be available to work Monday through Sunday, between 8:00 a.m. and 8:00 p.m. (7.5 hours shift)