Healthfirst

The Operations Call Center Service Agent is responsible for assisting members & providers with issues and inquiries about our members and their insurance, applications and/or claims in one or more families of products, i.e. Medicare, Medicaid. The Service Agent is also responsible for receiving and addressing member & provider inquiries, resolution of complaints, client education, retention of membership and dis-enrollments, and escalation of issues requiring additional intervention.

Duties and Responsibilities Provides excellent quality customer service to our members and/or providers relating to all aspects of member/provider questions and issues such as eligibility, benefits, claims process, escalations, and product questions, etc. May include but is not limited to inbound/outbound calls/emails/chats, onsite/remote/virtual/field location, on behalf of CCO.Meets/Exceeds all performance KPIs including but not limited to quality, productivity, and dependability   Follows established policies and procedures to ensure member and provider issues are addressed timely and accurately Identifies and de-escalate situations where member/provider is upset and provides resolution for their issue.  Initiates investigations as required, partnering with other assigned parties to participate in root cause analysis, takes proactive and/or corrective measures and/or recommends solutions and methods for process improvement and follow-up on outstanding customer inquiries and complaints within defined timeframe. Complies with HIPAA requirements and maintains Protected Health Information (PHI) confidentiality of member, provider, medical and departmental information, and adheres to local, state, federal and Healthfirst specific compliance and regulatory guidelines. Builds sustainable relationships of trust through open and interactive communication with internal and external customers. Works a flexible schedule including a late shift, weekends, and/or holidays (with limited notice at times), and as needed during unforeseen business disruptions. Additional duties as required. Minimum Qualifications: High School Diploma or GED from an accredited institution Prior experience in a customer service environment Experience participating in cross-functional projects and departmental initiatives related to customer/client interaction and customer service. Working experience in a fast-paced environment. Proficient in Microsoft Office Suite applications including Excel, Word, and Outlook. Preferred Qualifications: Associate’s or Bachelor’s Degree from an accredited institution or equivalent work experience Proven track record of exercising independent thinking, problem solving and achieving goals. Knowledge and experience with a traditional and/or omnichannel contact center with emphasis in the healthcare industry, may include but not limited to KPIs, CMS/NYSOH requirements (including CMS STARS programs) and call center operations in general. Experience navigating multiple technologies including a Customer Relationship Management System (i.e., locate information, route future actions, notate resolutions, update member information, etc.) Basic knowledge of operational health plan departments and functionality. Working knowledge of Microsoft Office Power Point. Excellent verbal and written communication and the ability to document grammatically correct emails, communications, and presentations. Basic understanding of call center metrics including Average Handle Time (AHT), Quality, etc. Compliance & Regulatory Responsibilities: See Above License/Certification: N/A

Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $38,200 - $49,920 All Other Locations (within approved locations): $33,300 - $47,840 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.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.