Member Engagement Representative

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Member Engagement Representative

San Juan, PR

JOB NATURE

Primary liaison between Triple-S organization and enrolled beneficiaries, new and re-enrolled prospects and providers for members/providers services, education, issues resolution, and customer satisfaction. Responsible for handling all member dissatisfaction, questions or doubts through the telephone line, provide orientations and manage any situations presented during the call or forward it to the appropriate department to solve the issue immediately, to ensure membership retention and engagement.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Conduct inbound and outbound calls through the telephone line to provide orientation and identify and resolve any possible situation presented during the call.

• Responsible for the follow up calls to give status, orientations or resolutions about matters brought to his attention by a customer.

• Responsible for achieving the percentage of assigned productivity.

• Resolve member issues immediately or forward to the appropriate department or division to be handle. Address any questions or issues customers may have.

• Track and document calls and member engagement initiatives.

• Go off-script when necessary to build a relationship with customers or answer any questions they have not addressed in the script.

• Perform appropriate member orientations calls accordingly to member issues or situations (enrollment, cancellation, disenrollment, service issues, missing ID card, benefits orientations, and claims, among others).

• Perform excellent orientation to assist members on the change of coverage process.

• Identify member grievances and appeals and resolve them in accordance to CMS regulations and the organization's policies and procedures.

• Responsible of making the proper documentation in the appropriate systems.

• Check all applications for the completeness and accuracy of information before or during the call to give proper information.

• Complete forms and record logs to create accurate, detailed files for each customer, providing insight into the target audience and what they want from the company.

• Conduct quality surveys to understand in satisfaction or disenrollment reasons. Provide product or process orientation to unsatisfied members and manage objections to ensure that the member may consider return to the plan.

• Maintain and comply with the established percentage for the metrics and monitoring process.

• Other tasks as assigned.

EDUCATION, TRAINING, and/or PROFESSIONAL EXPERIENCE

Associate's Degree (60-64 college credits) in Business Administration, Arts or Science with one (1) to three (3) years of experience in the Health Insurance Industry working in a Sales and/or Call Center environment, preferable. Or three (3) to five (5) years of this experience in lieu of.

CLOSED DATE: 01/31/2024

It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, gender, gender identity, real or perceived sexual orientation, civil status, social condition, political ideologies, age, physical or mental disability, veteran status or any other characteristic protected by law. Drug-free company.

Equality Employment Opportunity/Affirmative Action for Minorities/Females/People with Disabilities/Veterans”. Employer with E-Verify to verify the eligibility of employment of all the new employees.

We encourage Females, Veterans and Disabled to Apply