Customer Services Representative I

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 Representatives (CSRs) are responsible for providing comprehensive high-quality service to all customers. The primary responsibilities, include but are not limited to, answering customer calls, proactively working to resolve our members and providers questions and concerns, responding to and documenting all customer encounters, intaking complaints, conducting outreach and retention efforts, assisting with Primary Care Provider (PCP) selections and handling all provider inquiries related to eligibility, claims and authorizations.

• 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/reassign projects.
• Process premium payments.
• All other duties and special projects as assign by the Director of Customer Service.
• Ability to work between 8:00 AM and 6:00 PM Monday - Friday, and 9:00 AM-5:00 PM Saturday.
• Training class (Paid): 9:00 AM-5:00 PM Monday-Friday.

• High School graduation or evidence of having satisfactory passed a High School Equivalency Program; and
• Minimum 1 year experience in a call center environment; or
• A satisfactory equivalent combination of education, training, and experience.
• Managed care experience preferred.
• 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.
• Ability to work in a fast-paced environment while keeping a high attention to detail.

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical Skills
• Written/Oral Communication

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