Call Center Representative I

Call Center Representative I Job Ref: 133329 Category: Member Services Department: CALL CENTER Location: 50 Water Street, 7th Floor, New York, NY 10004 Job Type: Regular Employment Type: Full-Time Salary Range: $48,791.00 - $48,791.00

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health + Hospitals MetroPlus Health 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, MetroPlus Healths network includes over 27,000 primary care providers, specialists, and participating clinics. For more than 40 years, MetroPlus Health has been committed to building strong relationships with its members and providers.

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.
• Handling all provider inquiries related to eligibility, claims, and authorizations.

Work Shifts

• 8:00 A.M. - 4:00 P.M.
• 9:00 A.M. - 5:00 P.M.
• 10:00 A.M. - 6:00 P.M.
• 11:00 A.M. - 7:00 P.M.
• 12:00 A.M. - 8:00 P.M.

Duties & Responsibilities

• 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 plans 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 reassignment projects.
• Process premium payments.
• All other duties and special projects as assigned 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.

Minimum Qualifications

• High School graduation or evidence of having satisfactorily passed a High School Equivalency Program.
• 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, doctors 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

Benefits NYC Health + Hospitals offers a competitive benefits package that includes:

• Comprehensive Health Benefits for employees hired to work 20 hrs. per week.
• Retirement Savings and Pension Plans.
• Paid Holidays and Vacation in accordance with employees Collectively bargained contracts.
• Loan Forgiveness Programs for eligible employees.
• College tuition discounts and professional development opportunities.
• College Savings Program.
• Union Benefits for eligible titles.
• Multiple employee discounts programs.
• Commuter Benefits Programs.