Customer Service Representative

About the role

The Customer Service Representative provides guidance to customers and prospects on the company’s products and services, handling complex inquiries and ensuring a seamless service cycle.

Key responsibilities

• Receive, resolve, or forward service requests such as eligibility checks, policy cancellations, card replacements, premium collections, and reimbursement requests.
• Document every interaction in the Q‑minder app, CRM, and Gits to guarantee continuity and compliance.
• Analyze each member’s situation to determine the appropriate action and keep the customer informed of status and outcomes.
• Support internal departments, including Sales, Stars, and Vision, by processing authorizations, HRA calls, and provider inquiries.
• Prepare coverage certifications, non‑covered service letters, and other required documentation while maintaining 100% accuracy.

Required profile

• At least 60 college credits (or an Associate’s degree) and 1‑2 years of customer‑service experience.
• Valid driver’s license for Puerto Rico and availability to work weekends, holidays, and other service centers as needed.
• Intermediate proficiency in both Spanish and English (writing, speaking, reading).

Required skills

• Proficiency with CRM case‑referral tools.
• Experience using Q‑minder application.
• Familiarity with Gits documentation system.