Job Description

Stars Call Center Representative Location San Juan, PR (Hato Rey Central area) :

Representante de Centro de Llamadas Stars

Regular

Non-Exempt

GENERAL DESCRIPTION:

Makes and answers phone calls from policyholders and providers regarding the Medicare Star Program strategies and initiatives. Solves and forwards situations through the established operational processes and guides. Documents the service provided to make sure to keep a record of the contact made with customers and providers.

ESSENTIAL FUNCTIONS:

• Makes and answers phone calls related to strategies and initiatives of the Medicare Star Program, complying with the established call protocol to provide quality service.
• Complies with the quality standard (98%) and service established in overseeing the calls received by the unit.
• Answers an average number of calls daily with 85% to 90% productivity compared to work team results.
• Complies with and uses the ACD ASPECT connection system, connecting according to their work itinerary and maximizing call time to avoid affecting the Call Center performance metric of answering between 85% and 90% of calls in the first 30 seconds without exceeding three percent abandonment.
• Meets the established work schedule to not affect it and the schedule compliance standard (97%).
• Evaluates, solves, and documents the situations presented by policyholders and providers regarding the department's strategies through the call.
• Prepares and manages documentation related to STARS strategies and initiatives.
• Coordinates appointments for policyholders with physicians and health providers as needed and supports the strategies overseen in the call center.
• Meets the established documentation parameters (98%) in the service provided through the call received and/or dialed.
• Forwards service situations to the corresponding operational areas.
• Complies fully and consistently with the Company's standards, policies, procedures, and local and federal laws applicable to our industry and business and employment management and practices.

• May perform other duties and responsibilities as assigned in accordance with the education and experience requirements contained in this document.

MINIMUM QUALIFICATIONS

Education and Experience: Four-year 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.

OR

Sixty (60) university credits equivalent to two (2) years of studies 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

Bachelor's degree from an accredited institution. At least one (1) year 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. Knowledge of Power MHS, INFOTEC, COGNOS, Envision Rx, Voyager, Net Claim, Fastrive, BDS, IHealth Claim Inquiry Tool, CCMS, Starstrack, and Provinet.

Languages: Spanish - Intermediate (writing, comprehension, and conversational) English - Intermediate (writing, comprehension, and conversational)

“Somos un patrono con igualdad de oportunidad en el empleo y tomamos Acción Afirmativa para reclutar a Mujeres, Minorías, Veteranos Protegidos y Personas con Impedimento ”

Job Tags

Full time, Local area, Rotating shift, Weekend work,

Similar Jobs