Customer Service Representative I – SC

About the role

The Customer Service Representative I – SC provides assistance to customers and prospects regarding the company’s health insurance products and services, handling inquiries, service requests, and documentation.

Key responsibilities

• Handle and resolve service requests such as eligibility inquiries, policy changes, duplicate cards, coverage certifications, premium collections and reimbursement requests.
• Prepare coverage certifications, letters of non‑covered services and maintain accurate policyholder demographic data.
• Log cases in the CRM system, keep customers informed of status, and document all steps to ensure compliance with service standards.
• Manage inbound calls from members, address complex benefit and coverage questions, and follow up on unresolved issues.
• Refer complaints to the appropriate unit and support other departments with health risk assessment calls.

Required profile

• Bachelor’s degree or 60‑64 college credits (associate’s level) or high school diploma with relevant experience.
• Minimum of 6 months to 2 years of customer service experience, preferably in a health‑insurance call center.
• Intermediate proficiency in Spanish and English (reading, writing, speaking).