Customer Service Representative [40 Hours]

What We’re Looking for ⬇️

Responsibilities:

• Advocate for the member and/or caller by making the interaction hassle-free. Some examples would include contacting providers, pharmacies, or ancillary providers.
• Compassionately own problem through to resolution on behalf of the member in real-time or through comprehensive and timely follow-up with the member.
• Effectively ensures members are connected to appropriate specialists and/or enrolled in the correct programs, based on members’ needs and eligibility.
• Compassionately respond and resolve member service inquiries related to:
  • Medical benefits, eligibility, and claims.
  • Terminology and plan design.
  • Billing inquiries.
  • Pharmacy benefits, eligibility, and claims.
  • Correspondence requests.
  • Accurately capture member grievances and file determination requests.
• Compassionately educate members about the fundamentals of health care benefits, including:
  • Managing health and well-being.
  • Offer Next Best Actions on the account and follow up appropriately.
  • Assist members in appointment scheduling to proactively address gaps in care.
  • Provider education and choosing a quality care provider.
  • Maximizing the value of their health plan benefits.
  • Pre-authorization and pre-determination requests and status.
  • Research complex issues across multiple applications and work with support resources to resolve customer issues.
• Provide compassion and maximize the use of community services, support programs, and resources available to members.
• Advocates must be experienced in member tools, benefit interpretation, and accurate documentation to interpret situations and proactively address member issues.
• Advocates must be able to proactively engage members in new opportunities to close gaps in care

Qualifications:

• High school graduate (must present diploma or certificate).
• English Level: Advanced.

Competencies and Specific Skills:

• Communication skills.
• Customer orientation (Empathy).
• Problem resolution.
• Attention to detail.
• Issue Resolution.
• Analytic Thinking.
• Flexibility.

Benefits:

• 40 hours per week
• 2 days off
• Salary: 1,700 soles
• Transportation*
• +15% variable 💸