Customer Service Representative I – Service Center

About the role

We are looking for a Customer Service Representative I to join our Service Center in Caguas. The role involves assisting members and prospects with inquiries about policies, benefits, and administrative requests, ensuring accurate and timely service.

Key responsibilities

• Handle and resolve service requests such as eligibility checks, policy cancellations, changes to IPAs and PCPs, duplicate card issuance, coverage certifications, premium and utility collections, and reimbursement inquiries.
• Prepare and issue coverage certification letters and non‑covered service notices according to policyholder requests.
• Maintain up‑to‑date demographic information in the internal database and register visitors in the system.
• Log cases in the CRM, keep customers informed of status, and document all steps taken to complete the service cycle.
• Manage inbound calls from the Call Center, address complex benefit and coverage questions, and follow up on unresolved issues.
• Escalate complaints to the appropriate unit following established protocols and support other departments with Health Risk Assessment calls.

Required profile

• Bachelor’s degree from an accredited institution.
• Minimum six years of experience in customer service or call‑center environments.
• Strong knowledge of insurance or health‑care policies and procedures.
• Ability to work accurately under established standards for wait times, transaction accuracy, and error rates.

Required skills

• Proficiency with Customer Relationship Management (CRM) systems.