Duties/Responsibilities:
Provide high-quality customer service to providers and members across all LOBs with a variety of questions and issues on topics such as eligibility, benefits, claims process, escalations, and products
Manage face-to-face encounters by interacting with customers to provide information in response to inquiries about products and services, improve overall member experience, and reduce waiting time to expedite traffic flow
Identify and de-escalate situations where member/provider is dissatisfied and provide a satisfactory resolution
Build sustainable relationships of trust through open and interactive communication with internal and external customers
Provide ad-hoc assistance to cross functional teams working on campaigns and case reviews to ensure standards are met
Partner with other Healthfirst member-facing departments by participating in community events to engage and educate existing/prospective members
Comply with HIPAA requirements and maintain Protected Health Information (PHI) confidentiality of member, provider, medical and departmental information; adhere to local, state, federal and Healthfirst specific compliance and regulatory guidelines
Assist periodically with weekend responsibilities at Healthfirst Community Offices (CO) or other events
Initiate investigations, partner with other assigned parties to participate in root cause analysis, communicate complex information, take proactive and/or corrective measures and/or recommend solutions and methods for process improvement and follow-up on outstanding customer inquiries and complaints within defined timeframes
Assist with Contact Center Operations (CCO) outbound campaigns on high volume days, while meeting deliverables associated with individual and team accountabilities
Additional duties as assigned
Minimum Qualifications:
High School Diploma or GED equivalent from an accredited institution
Experience in a customer service environment
Experience handling escalated issues, complex situations, and interactions requiring conflict resolution, active listening skills, and empathy
Experience working in a fast-paced environment that requires handling multiple priorities simultaneously
Willing to accommodate flexible business needs (Ex: nights, weekends, holidays, alternate locations, and/or overtime with limited notice)
Work experience with Microsoft Office Suite applications including Excel, Word, and Outlook
Work experience requiring effective communication verbally and in writing while demonstrating good grammar, spelling, and punctuation skills
Preferred Qualifications :
Associate Degree from an accredited institution or equivalent work experience
Ability to exercise independent thinking, problem solving and achieving goals
English proficient bilingual who also speaks Spanish, Russian, Mandarin/Cantonese, Haitian Creole, Korean, Bengali, Punjabi, Hindi, or Urdu
Basic knowledge of operational health plan departments and functionality
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
Trained in multiple Healthfirst LOBs for both Member and Provider Family of Products (FOPs)
Compliance & Regulatory Responsibilities : See Above
License/Certification: N/A
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.
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