Customer Service Representative

Job Summary

This role supports a global insurance client by handling workers compensation claims and providing empathetic customer service in a hybrid work model. The specialist reviews claim details updates records and communicates with claimants and internal teams in Spanish and English. The role focuses on accurate claim handling timely resolution and a positive service experience.

Responsibilities

• Handle end to end workers compensation claims by gathering details validating coverage and documenting every interaction to ensure accurate and timely case resolution
• Provide empathetic customer service by actively listening to injured workers employers and medical providers and offering clear explanations that reduce stress and confusion
• Review claim documents medical reports and wage information to determine compensability and benefits while maintaining compliance with company policies and applicable regulations
• Coordinate with internal teams such as claims examiners nurses and legal specialists to support thorough and fair claim decisions that align with organizational standards
• Update claim management systems with detailed notes payment information and status changes to maintain accurate records and enable effective reporting
• Communicate in Spanish and English with customers and stakeholders by phone email and chat to ensure clear understanding of claim status and next steps
• Resolve customer inquiries related to claim status payment schedules documentation requirements and policy coverage in a timely and professional manner
• Identify potential issues such as missing documents conflicting statements or unusual claim patterns and escalate them to appropriate specialists to mitigate risk
• Follow standard operating procedures quality guidelines and service level agreements to deliver consistent and reliable claims service across all assigned cases
• Support continuous improvement initiatives by sharing insights on recurring customer issues system gaps or process inefficiencies that may impact service quality
• Collaborate in a hybrid work environment by managing time effectively balancing remote and office tasks and ensuring availability during rotational shifts
• Adhere to confidentiality standards data privacy rules and ethical guidelines to protect sensitive customer and company information throughout the claims lifecycle
• Contribute to the company mission by helping injured workers receive timely benefits thereby supporting financial stability and wellbeing in the broader community

Qualifications

• Demonstrate proven experience in customer service roles handling complex inquiries and resolving concerns with patience professionalism and clear communication
• Apply working knowledge of workers compensation claims processes including intake investigation benefit calculation and ongoing claim maintenance
• Utilize strong Spanish reading writing and speaking skills to support customers and stakeholders who prefer or require communication in Spanish
• Exhibit familiarity with insurance or claims administration environments including basic understanding of regulatory expectations and documentation standards
• Use productivity tools and claim management systems with accuracy and attention to detail to minimize errors and rework
• Show strong problem solving skills by analyzing available information identifying appropriate next steps and following through to closure for each claim
• Display flexibility to work rotational shifts in a hybrid model while maintaining consistent service quality and meeting performance metrics

Certifications Required

Preferred certifications include certification in customer service or insurance claims such as AIC or similar recognized claims qualification