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.
Additional duties as required.
Requirements:
Must be available for mandatory 8-week training class starting on Monday, July 21st.
Work a 40-hour week with a schedule assigned during the hours of 8am-8pm Monday thru Friday from April 1st to Sept 30th and Monday thru Sunday from Oct 1st to March 31st, including late shifts, weekends, and/or holidays including but not limited to Christmas Eve, New Year’s Eve, New Year’s Day, MLK Day and as needed during unforeseen business disruptions (with limited notice at times).
Designate, set up and maintain a physical workspace that is separate from the main flow of home or other traffic and is safe and secure to ensure PHI and other sensitive material are protected. The designated workspace must be HIPAA and OSHA compliant as well as comply with any departmental requirements.
Must have Secure Internet Service Provider (ISP) with appropriate speeds and bandwidth to support the remote nature of the role, including multiple applications and systems (required) to ensure clear and consistent communication with internal and external parties (i.e. members, providers and colleagues).
Must have a clear and direct connection into the ISP modem (must use ethernet cable from computer to the modem). Wi-Fi service / Wi-Fi Router (ex: T-Mobile) is NOT permitted.
Minimum Qualifications:
High School Diploma or GED from an accredited institution
Prior experience in a customer service environment
Working experience in a fast-paced environment.
Proficient in Microsoft Office Suite applications including Excel, Word, and Outlook.
Preferred Qualifications:
Associate 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.
Experience participating in cross-functional projects and departmental initiatives related to customer/client interaction and customer service
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): $39,208 - $52,000
All Other Locations (within approved locations): $34,091 - $49,920
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.