Customer Services Representative

Position Overview:

The Customer Services Representative provides comprehensive customer service to members, providers and prospective members. 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.

Key Responsibilities:

1. Record and respond to all Customer contacts and update in tracking system. Manage and ensure appropriate follow-up and closure for all customer contacts.
2. Provide on-site as well as telephone orientations to new and existing members.
3. Process and resolve complaints and record given information in the system.
4. Assist members with the selection and assignment of PCP’s.
5. Update all member demographic changes.
6. Provide all benefit/service related information to members, perspective members and providers.
7. Perform retention efforts for all lines of business.
8. Handle roster Inquiries
9. Handle disenrollment inquiries from members, providers and regulatory agencies.
10. Handle provider inquiries.
11. Schedule marketing appointments for prospective enrollees
12. Respond to all claim billing inquiries from providers and members
13. All other duties and special projects as assigned by Associate Executive Director

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.
• Proven experience in providing excellent service to customers in various healthcare related areas, (i.e. insurance, doctor’s office, medical clinics)

• Integrity and Trust

• Customer Focus

• Functional/Technical skills

• Written/Oral Communication

Company Description

MetroPlus provides access to health care services to New York City residents in Brooklyn, Queens, the Bronx and Manhattan through New York State's Medicaid Managed Care, Child Health Plus, Family Health Plus and Partnership in Care, an HIV Special Needs Program through its network of participating providers

Work location: New York, NY