Call Center Representative I

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

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 40 years, MetroPlusHealth 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 and handling all provider inquiries related to eligibility, claims and authorizations.

Work Shifts

9 : 00 A.M – 5 : 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 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.

Minimum Qualifications

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

Benefits

NYC Health and 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

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