JOB SUMMARY

Independently performs non-routine tasks in support of health services underwriting, renewal and claims processes applying various operational procedures and guidelines under general supervision. It can act as a trainer and involves the use of judgment to perform analysis and evaluation of requests to determine and execute the appropriate action.

ESSENTIAL FUNCTIONS

• Support, assist and guide customers who visit or call to handle their product requests health coverage and other policies.
• Processes required petitions to complete the transaction requested by the client such as payments, maintenance, subscriptions, refunds, claims, letters, certifications, activations, cancellations, pharmacy, and complaints and grievances.
• Analyzes and investigates customer requests and intervenes and works with other departments and divisions of the company to achieve the resolution of the case.
• Evaluates and determines the action to take regarding the client's requests, according to the applicable laws.
• Research and draft documents in English and Spanish answering requests if required.
• Assists the Supervisor, Manager, Director in meetings, preparation of reports, audits or any other item, as necessary.

EDUCATION

EXPERIENCE

• Associate Degree in Business Administration, Marketing or Communications or at least 60 university or college credits, with one year of experience related to configuration processes, preferred.
• Or instead, High School Diploma with a minimum of 3 years of experience related to configuration processes, preferably.

LICENSES AND CERTIFICATIONS

COMPETENCIES