Regular
Non-Exempt
GENERAL DESCRIPTION:
Responsible for monitoring customer service operations, focusing on closing service cycles with sustainable solutions and addressing escalated issues related to benefits and products. Strengthens relationships with service providers and internal departments to enhance customer access. Supports the implementation of special initiatives and monitors service calls to ensure compliance with established service indicators and regulatory standards, all while prioritizing a memorable service experience to foster customer retention and loyalty.
ESSENTIAL FUNCTIONS:
Responsible for aiding and monitoring the Representatives with situations presented by customers regarding coverages, benefits, access to services, and processes, guaranteeing that they are addressed as quickly as possible and complying with established service standards.
Assists in complex referrals that cannot be overseen by the Representatives and need to be scaled up, to provide excellent service and improve member experience.
Supports the Customer Resolution unit in the management of member experience efforts and special initiatives such as Voice of the Customer (VoC) surveys, Detractors' Strategy, Micro Network Program, among others, guaranteeing that customer feedback is taken into consideration and that the service cycle is closed in each intervention.
Advises Representatives in identified areas to improve their performance or assist in their professional development.
Supports the management in the workload distribution between Representatives and monitors productivity and output.
Suggest topics, identify training and re-training needs for the unit staff, and integrate the management input.
Analyze the Representative's documentation reports to guarantee compliance with established requirements and the quality of the information included. Assist in the preparation or revision of guides and other materials that help the Service Representative with their tasks.
Takes part in external company activities, meetings, or forums on behalf of the team to resolve service issues.
Works with other units to continue optimizing processes and seeking optimal and innovative solutions that promote customer satisfaction, retention, and loyalty, and improve member experience.
Supports initiatives, in collaboration with the different teams, focused on enhancing the customer experience and removing friction points or any other tactic or effort that might impact retention, loyalty, and member experience for the different Company lines of business.
Supports the Unit processes, Inbound Call Center operations, and Mitigation Plan according to operational needs.
Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
May perform other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.
Minimum Qualifications
Education and Experience: Bachelor's in Business Administration or related fields. At least one (1) year of experience working in customer service areas, preferably in a Call Center in the Health Insurance Industry.
OR
Education and Experience: Associate Degree or sixty (60) to sixty-four (64) approved college credits. At least two (2) years of experience working in customer service areas, preferably in a Call Center in the Healthcare Insurance industry.
OR
Education and Experience: High School Diploma or Technical Course. At least three (3) years of experience working in customer service areas, preferably in a Call Center in the Healthcare Insurance industry.
"Proven experience may be replaced by previously established requirements."
Certifications / Licenses: N/A
Other: N/A
Languages:
Spanish – Intermediate (comprehensive, writing and verbal)
English – Intermediate (comprehensive, writing and verbal)
"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"
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