Internal Account Executive

Regular Exempt GENERAL DESCRIPTION: Responsible for delivering exceptional service to employers, producers, and subscribers, as applicable. Receives and manages client inquiries, providing comprehensive orientations, and formulating effective solutions to various challenges that may arise. Identifies and resolves issues, escalating them as necessary to ensure timely resolution. Follow-up on all concerns until solutions are achieved, with clear communication of these resolutions to all relevant stakeholders. ESSENTIAL FUNCTIONS:
• Receives, handles, routes, and resolves service inquiries that come through the Employer Service Units. Service cases may be received via phone through the system, fax, email, or mail, directly from either the producer or the client contact.
• Generates calls to health facilities, providers, or pharmacies that provide services to customers as part of the resolution of pending cases.
• Handles, forwards, and resolves service situations or complex cases for customers, which may be initiated by client contacts, producers, or agents. Also manages direct calls from subscribers regarding benefits orientations, eligibility changes, card issuance, enrollments, cancellations, membership lists, Explanation of Benefits (EOBs), coverage certifications, pharmacy issues, benefit verifications, co-payments, procedure codes, reimbursements, pre-authorizations, and provider invoices, while also providing network directories for services in the United States and Puerto Rico and ensuring thorough follow-up on all cases until resolution.
• Utilize digital tools to document all managed cases and assist the Account Executives with special service situations reported by clients, Policyholders, Agents, and Producers (for example: PA status, tests, and treatments in PR, US, or outside the US, among others).
• Maintains a record of service guarantees agreed with clients and/or producers and records the situations handled.
• Maintains effective communication with other departments to resolve situations.
• Participate in group activities or special events, as needed.
• Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
• May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document. MINIMUM

QUALIFICATIONS:
Education and

Experience:
Bachelor's Degree in Business Administration, Public Administration, Health Services Administration, or related fields. At least one (1) year of experience in customer service, account management, or performing similar functions in the Healthcare Insurance Industry is preferred. OR Education and

Experience:
Associate's Degree. At least three (3) years of experience in customer service, account management, or performing similar functions in the Healthcare Insurance Industry is preferred. “Proven experience may be replaced by previously established requirements.” Certifications / Licenses: A valid Life and Disability Insurance Agent License and Health Services License is preferred. Other: N/A Languages: Spanish – Advanced (writing, conversational, and comprehension) English – Intermediate (writing, conversational, and comprehension) “We are an Equal Employment Opportunity Employer and take Affirmative Action to recruit Protected Veterans and Individuals with Disabilities.”