Customer Service Representative I - CC

GENERAL DESCRIPTION: Responsible for providing high-quality customer service to policyholders, members, and providers through inbound calls. Effectively resolves service inquiries in accordance with established operational processes and service guidelines, while accurately documenting all interactions to ensure service continuity and compliance with Call Center standards. ESSENTIAL FUNCTIONS: • Ensures confidentiality, security, and proper handling of customer, member, and provider information by complying with the Health Insurance Portability and Accountability Act (HIPAA) requirements, data privacy policies, and all applicable regulatory and company guidelines during all customer interactions and system usage. • Handles inbound calls following established call protocols to deliver quality service, achieve first call resolution, and appropriately evaluate, resolve, document, or escalate customer inquiries in accordance with policies and procedures. • Meets established key performance indicators (KPIs), including productivity, schedule adherence, call handling, quality standards, accurate documentation, and professional customer interactions, in compliance with approved protocols. • Participates in initiatives as required, supporting efforts to enhance operational efficiency, productivity, and service quality within the Call Center, in alignment with established processes and performance objectives. • Provides feedback and participates in continuous improvement efforts by identifying service gaps, recurring issues, or process inefficiencies observed during customer interactions. • Adheres to established operational policies, procedures, scripts, and service guidelines to ensure consistent and compliant service delivery. • Utilizes the telephone system in accordance with assigned schedules and operational guidelines to support call center performance metrics. • 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 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 one (1) year 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 two (2) 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: Not required. Other: Knowledge of medical billing, preferably. Availability to work rotating shifts, Saturdays, Sundays, and holidays, per the operation’s requirements. Customer Service oriented, keyboard and telephone etiquette knowledge. Languages: Spanish – Basic (comprehensive, writing and verbal) English – Basic (comprehensive, writing and verbal)