Customer Service Representative II

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

Customer Service Reps are responsible for providing comprehensive high-quality service to all customers. The primary responsibilities, include but are not limited to documenting all customer contacts into the tracking system, process complaints, conduct outreach efforts, assist in PCP selection, conduct new member orientations, claims review inquiries, handle provider and utilization management inquiries, etc. Under the Level II title, the Customer Service Representative will continue Level I functions and be assigned additional responsibilities in areas that require assistance such as providing support to management staff and escalate issues within Call Center.

• Assist management staff with special projects: i.e., PCP monthly projects (MIS-Assignments, PCP error reports)
• Record and respond to all Customer contacts and update in tracking system. Manage and ensure appropriate follow-up and closure for all customer contacts.
• Provide on-site as well as telephone orientations to new and existing members.
• Strive for first call resolution, working to resolve member and provider issues as the point of contact
• Utilize dual monitors and leverage computer-based resources to find answers to customer questions
• Research and respond accurately to all customer inquiries related to eligibility, benefits/ services, claims and authorizations.
• Classify and record all customer encounters clearly and concisely.
• Identify and escalate complex issues and provide follow-up/ closure.
• Identify and intake customer complaints capturing all pertinent information.
• Assist members with PCP selection, as well as, locating providers and vendors within Plan's network.
• Verify and update member demographic information.
• Process requests for member materials, such as ID cards, member guide, provider directory, etc.
• Handle enrollment inquiries and generate sales leads.
• Handle disenrollment requests and pro-actively conduct retention efforts.
• Perform outreach related to New Member Orientation and PCP Term/ Resign projects.
• Process premium payments.
• All other duties and special projects as assign by the Director of Customer Services.
• Ability to work between 8:00AM and 8:00PM Monday - Friday, and 9:00AM-5:00PM Saturday
• Training class (Paid): 9:00AM-5:00PM Monday-Friday

• High School graduation or evidence of having satisfactory passed a High School Equivalency Program; and
• 3 year of experience in a call center environment handling high volume of calls required
• Proven experience in providing excellent service to customers in various healthcare related areas, (i.e. insurance, doctor's office, medical clinics)
• Poise under pressure when dealing with difficult situations and potentially upset customers

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional & Technical Skills
• Written/Oral Communication
• Ability to work in a fast-paced environment while keeping a high attention to detail

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