Call Center Representative

Job Summary

We are seeking a Call Center Representative for a opportunity in San Juan, PR within the healthcare services industry. This role serves as a primary point of contact for members, prospective members, re-enrolled individuals, and providers, helping resolve questions, service concerns, enrollment matters, benefits inquiries, and other customer care needs.

The Call Center Representative will work in a professional, office-based call center environment with a strong focus on service quality, member satisfaction, retention, and accurate documentation. This is a great opportunity for a customer-focused professional who enjoys helping people, working with healthcare information, and being part of a supportive team environment where communication, accuracy, and follow-through are valued.

This position is ideal for someone with call center, customer service, sales, or health insurance experience who can manage inbound and outbound calls, remain calm under pressure, and provide clear guidance to members while following established policies and regulatory requirements.

Key Responsibilities
- Handle inbound and outbound calls to provide member orientation, answer questions, and resolve customer service issues.
- Follow up with members regarding pending inquiries, case status, orientations, and issue resolutions.
- Identify and address member concerns related to enrollment, cancellation, disenrollment, ID cards, benefits, claims, service issues, and coverage changes.
- Document calls, member interactions, grievances, appeals, surveys, and engagement activities accurately in the appropriate systems.
- Escalate or route unresolved issues to the appropriate department while ensuring timely service and a positive member experience.
- Meet assigned productivity, quality, monitoring, and customer satisfaction metrics in accordance with organizational standards.

Compensation and Benefits

- Pay: $13 per hour.
- Location: San Juan, PR.
- Work Environment: Indoor office setting with environmentally controlled conditions and moderate sound level.
- May require extended hours and work under time-sensitive deadlines.

Equal Opportunity Employer / Disabled / Protected Veterans

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For temporary assignments lasting 13 weeks or longer, AppleOne is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.

We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.

AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.

We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

Additional Skills

Required Qualifications and Skills

- Conduct member and provider service calls related to healthcare benefits, enrollment, claims, grievances, and issue resolution.
- Track, document, and follow up on customer interactions using internal systems and required forms.
- Support member retention by managing dissatisfaction, answering questions, and providing clear product or process orientation.
- Maintain productivity, quality, and compliance standards in a healthcare call center environment.

- Associate degree with 60 to 64 college credits in Business Administration, Arts, Science, or a related field.
- 1 to 3 years of experience in the health insurance industry, preferably in a sales and/or call center environment.
- Strong customer service, call handling, and telephone communication skills.
- Ability to explain healthcare, benefits, enrollment, and service-related information clearly and professionally.
- Strong documentation skills with attention to accuracy, completeness, and detail.
- Ability to identify grievances and appeals and handle them according to applicable regulations, policies, and procedures.
- Comfortable working in a metrics-driven environment with productivity, quality, and monitoring expectations.
- Ability to manage difficult conversations, handle objections, and build rapport with members.
- Strong problem-solving, follow-up, organization, and time management skills.
- No license or certification required.

Preferred Qualifications

- Prior experience in healthcare, health insurance, managed care, member services, provider services, or a related call center environment.
- Experience handling enrollment, disenrollment, benefits orientation, claims questions, grievances, appeals, or member retention calls.
- Ability to go off-script when appropriate to build trust, clarify concerns, and provide a better customer experience.