Service Advocate

Duties and Responsibilities

• Provide excellent quality customer service to Signature HMO Plan Members and/or across all Lines of Business (LOBs) for members and providers with a variety of questions and issues on topics such as eligibility, benefits, claims process, escalations, and product
• Communicate with members and providers through various channels which may include but are not limited to inbound and outbound calls, emails, or chats
• Manage the relationship and resolution of Member inquiries with respect to all Healthfirst vendor partners in concert with or on behalf of the Member(s)
• Meet or exceed all performance KPIs including but not limited to quality, productivity, and dependability
• Follow established policies and procedures to ensure member and provider issues are addressed timely and accurately
• Identify and de-escalate situations where member/provider is upset and provide a satisfactory resolution
• Initiate investigations as required, partnering with other assigned parties to participate in root cause analysis, communicate complex information, take proactive and/or corrective measures and/or recommend solutions and methods for process improvement and follow-up on outstanding customer inquiries and complaints within defined timeframe
• Assist with CCO inbound contacts on high volume days, while not missing any deliverables associated with their individual and team accountabilities
• Comply with HIPAA requirements and maintain Protected Health Information (PHI) confidentiality of member, provider, medical and departmental information; adhere to local, state, federal and Healthfirst specific compliance and regulatory guidelines
• Build sustainable relationships of trust through open and interactive communication with internal and external customers
• Work at locations which may include office, remote, virtual and/or field offices
• Additional duties as required

Requirements:

• Work a 40-hour week with a schedule assigned during the hours of 8am-8pm Monday thru Friday from April 1st to Sept 30th and Monday thru Sunday from Oct 1st to March31st, including late shifts, weekends, and/or holidays including but not limited to Christmas Eve, New Year’s Eve, New Year’s Day, MLK Day and as needed during unforeseen business disruptions (with limited notice at times).
• Designate, set up and maintain a physical workspace that is separate from the main flow of home or other traffic and is safe and secure to ensure PHI and other sensitive material are protected. The designated workspace must be HIPAA and OSHA compliant as well as comply with any departmental requirements.
• Must have Secure Internet Service Provider (ISP) with appropriate speeds and bandwidth to support the remote nature of the role, including multiple applications and systems (required) to ensure clear and consistent communication with internal and external parties (i.e. members, providers and colleagues).
• Must have a clear and direct connection into the ISP modem (must use ethernet cable form computer to the modem). WIFI is NOT permitted.

Minimum Qualifications:

• High School Diploma or GED from an accredited institution
• Healthfirst Contact Center Operations work experience
• Work experience handling escalated issues, complex situations, & calls requiring conflict resolution
• Work experience with all CCO-related systems (Salesforce, PEGA, TruCare, MHS, etc.)
• Basic understanding of call center metrics including Average Handle Time (AHT), Quality, etc.
• Experience participating in cross-functional projects and departmental initiatives related to customer/client interaction and customer service
• Working experience in a fast-paced environment that requires handling multiple priorities simultaneously
• Proficient in Microsoft Office Suite applications including Excel, Word, and Outlook

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Preferred Qualifications:

• Associate Degree from an accredited institution or equivalent work experience
• Proven track record of exercising independent thinking, problem solving and achieving goals
• Bilingual (English and Spanish, or Mandarin/Cantonese)
• Trained in multiple Healthfirst LOBs for both Member and Provider Family of Products (FOPs)
• Working knowledge of Microsoft Office Power Point
• Excellent verbal and written communication and the ability to document grammatically correct emails, communications, and presentations

Compliance & Regulatory Responsibilities: See Above

License/Certification: N/A

Hiring Range*:
*

Greater New York City Area (NY, NJ, CT residents): $47,403 - $62,400
*

All Other Locations (within approved locations): $41,101 - $60,320

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

• The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role.

41100-60320

Salary : $41,101 - $60,320