Job Purpose

As a Third-Party Administrator for dozens of Healthcare Insurance companies located overseas, the Customer Service Representative is responsible to handle Inbound requests received via phone and email for “Expat”, “Destination” and “Travel” patients whose medical services will take place either in the United States or the rest of the world. Besides providing coverage details to medical Providers/insured Members, coordinating cashless appointments worldwide, providing bill status information to Providers, the CSR will work closely with the Case Management department on services that require an authorization which include identifying services that must be pre-certified and initiating the pre-authorization process. Last but not least, the CSR will be working with Account Management for any bill related matters that need to be escalated.

Main daily responsibilities, but not limited to:

- Direct communications with Members, Providers, Corporate Clients via phone, email and any type of communication.
- Register Policies in the system with proper eligibility, add Members/dependents and create appropriate tasks that will trigger proper workflow
- Documentation of all calls or communications in the Members record (when applicable)
- Confirmation of Benefits and Eligibility information to members and providers.
- Identify medical services that require an authorization from the Corporate Client and take appropriate actions (initiate authorization, provide status on existing ones and escalate any issues to Case Management)




- Coordination of medical services in/outside the USA, this, in most cases, include locating and contacting several Providers who have the availability and suit the Members preferences and accept our Guarantee of Payment for a cashless experience.
- Respond to general queries from members (policy procedures, reimbursements, etc.). Redirect callers when necessary

Requirements

- Trilingual (Spanish, English & French)
- Must be detail-oriented and organized
- Must possess critical thinking skills as well as the ability to manage time efficiently.
- Must be able to gather the information necessary to assist customers.
- Always be sharp and alert.
- Needs to communicate well with co-workers (verbal and written).
- Knowledge of phone manners, etiquette and protocols.
- Professional phone etiquette and written skills
- Ability to adapt to changes
- Able to understand, interpret and explain policies and procedures as well as knowledge of commonly used concepts, practices and procedures in the field.
- Ability to deal with irate customers and complaints while maintaining composure and control of the situation.
- Knowledge of Microsoft Office.

Tipo de puesto: Tiempo completo, Por tiempo indeterminado

Ventajas

- Programa de referidos
- Prestaciones de Ley
- Seguro de gastos médicos mayores
- Seguro de vida
- Vacaciones de Ley
- Vales de Despensa
- Prima Vacacional 100%
- Aguinaldo 30 Días

Idioma

- Inglés y Francés (Obligatorios)

Lugar de trabajo: Empleo presencial

📌 Customer Service Representative- Trilingual (Spanish, English and French)- Provider Assist (Ciudad de México)
🏢 ChoiceNet International Mexico S.A. de
📍 Ciudad de México