Bilingual Medicare Call Center Rep - Work From Home

About the Role

Employment Type: Full time

Become a part of our caring community and help us put health first. The Medicare Call Center Representative 2 represents the company by addressing incoming telephone, digital, or written inquiries from Medicare members. The Medicare Call Center Representative 2 performs varied activities and moderately complex administrative / operational / customer support assignments. Performs computations. Typically works on semi-routine assignments.

Responsibilities

• Addresses customer needs which may include complex benefit questions, resolving issues, and educating members.
• Records details of inquiries, comments or complaints, transactions or interactions and takes action accordingly.
• Escalates unresolved and pending customer grievances.
• Decisions are typically focused on interpretation of area / department policy and methods for completing assignments.
• Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization / timing, and works under minimal direction.
• Follows standard policies / practices that allow for some opportunity for interpretation / deviation and / or independent discretion.
• Handles 20 to 35 inbound calls daily from Medicare members with a focus on high-quality service and one-call resolution.
• While the associate receives inbound calls, 60% to 70% of them require associates to place outbound calls to physicians, DME vendors, pharmacies or other entities to help members.
• Records details of inquiries, comments or complaints, transactions, or interactions, and takes action accordingly.
• Escalates unresolved and pending customer grievances.
• Decisions are typically focused on interpretation of area / department policy and methods for completing assignments.
• Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction.
• Follows standard policies / practices that allow for some opportunity for interpretation/deviation and / or independent discretion.
• Requires strong emotional intelligence to proactively provide solutions, ensuring the member's utmost health and safety.

Work Schedule

• Projected start date: October 13, 2025.
• Virtual training: Will start on day one of employment and runs for the first 7 weeks, working any shift between the hours of 8:00 AM and 8:00 PM Eastern Time (9:00 AM to 9:00 PM AST during Daylight Saving Time), Monday through Friday, based on business needs.
• Post-training: Associates will be assigned to an 8-hour shift between the hours of 8:00 AM and 8:00 PM Eastern Time (9:00 AM to 9:00 PM AST during Daylight Saving Time), Monday through Friday.
• Flexibility: Must have flexibility to work weekends, holidays and/or mandatory overtime, based on business needs.
• Commitment: This position requires learning many systems, policies, and tools, and it takes time to become proficient in the role. You must be willing to remain in this position for a period of twelve (12) months before applying to other Humana opportunities outside the CarePlus Team.

Required Qualifications

• Must currently live in Puerto Rico.
• Bilingual Proficiency: Must be fully Bilingual in English / Spanish with the ability to speak, read, and write in both languages without limitations or assistance. If selected for the position, you will be required to take a Language Proficiency Assessment in English / Spanish.
• Customer Service Experience: 1+ years of customer service experience.
• Customer Service Skills: Demonstrated experience with providing strong customer service and attention to detail while actively listening.
• Prioritization Skills: Prior experience managing multiple or competing priorities, including use of multiple computer applications / systems simultaneously.
• Software Proficiency: Proficiency with Microsoft Office applications, particularly Outlook and Teams.
• Professionalism: Ability to maintain a professional demeanor, practicing strict confidentiality for all sensitive information.
• Initiative: Strong initiative.