Service Coordinator

General Description: Coordinates and ensures the efficient handling and distribution of service-related cases within the unit. Supports account executives by managing case flow, maintaining accurate records, and providing direct client support. Ensures timely responses to inquiries related to medical, pharmacy, and dental services, eligibility, and coverage, while also assisting with special initiatives and maintaining service quality standards.

Essential Functions: Coordinate and assign incoming service cases received via the Employer Services inbox to account executives, identifying the nature of each case, whether related to medical prior authorization (PA), pharmacy PA, dental PA, medication coverage clarification, reimbursement inquiries, provider service issues, Consolidated Omnibus Budget Reconciliation Act (COBRA) management, or eligibility a uniform distribution of cases among internal account executives, considering the number of executives available; considering that two account executives are assigned to specific VIP groups, handling all cases received from these groups. Generate and maintain case logs and reports detailing received and assigned cases for review by management. Respond to eligibility-related inquiries from clients or producers via phone or email, including reviewing enrollment forms and determining appropriate responses based on case complexity. Process medical plan card requests submitted by producers, clients, or account/sales executives, ensuring timely issuance and delivery. Prepare coverage certification documents for all client types, including insured groups and Administrative Services Only (ASO) accounts, covering both Puerto Rico and U.S.-based students. Monitor and adjust case assignments, responding to changes in staffing and case volume to maintain workflow efficiency. Review and validate clinical authorization case details to ensure accurate assignment to the appropriate internal resource. Facilitate document delivery in-person, including ID cards or other requested materials, at the lobby upon client or internal request. Escalate sensitive or complex cases to management, providing visibility into issues that may require higher-level intervention or decision-making. Contact clients or producers by phone as needed to provide general incoming cases received via RightFax and email, ensuring proper categorization and timely assignment, while also supporting special initiatives 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.

Education and Experience: Bachelor's Degree in Business Administration, Health Services Administration, or a related field. At least six (6) months of experience performing coordination, clerical, and/or sales-related duties, preferably in the Healthcare Insurance industry. OR

Education and Experience: Associate's Degree or at least sixty to sixty-four (60-64) approved college credits. At least one (1) year of experience performing coordination, clerical, and/or sales-related duties, preferably in the Healthcare Insurance industry. OR