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Customer Service Representative [40 Hours]
Image Icon Peru · Lima
Category Customer Service
Requisiton 1018

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
  • ON-Site: Magdalena

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 💸