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 productsManage 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 flowIdentify and de-escalate situations where member/provider is dissatisfied and provide a satisfactory resolutionBuild sustainable relationships of trust through open and interactive communication with internal and external customersProvide ad-hoc assistance to cross functional teams working on campaigns and case reviews to ensure standards are metPartner with other Healthfirst member-facing departments by participating in community events to engage and educate existing/prospective membersComply 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 guidelinesAssist 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 timeframesAssist with Contact Center Operations (CCO) outbound campaigns on high volume days, while meeting deliverables associated with individual and team accountabilitiesAdditional duties as assignedMinimum Qualifications:
High School Diploma or GED equivalent from an accredited institutionExperience in a customer service environmentExperience handling escalated issues, complex situations, and interactions requiring conflict resolution, active listening skills, and empathyExperience working in a fast-paced environment that requires handling multiple priorities simultaneouslyWilling 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 OutlookWork experience requiring effective communication verbally and in writing while demonstrating good grammar, spelling, and punctuation skillsPreferred Qualifications:
Associate Degree from an accredited institution or equivalent work experienceAbility to exercise independent thinking, problem solving and achieving goalsEnglish proficient bilingual who also speaks Spanish, Russian, Mandarin/Cantonese, Haitian Creole, Korean, Bengali, Punjabi, Hindi, or UrduBasic knowledge of operational health plan departments and functionalityKnowledge 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 generalTrained in multiple Healthfirst LOBs for both Member and Provider Family of Products (FOPs)Compliance & Regulatory Responsibilities: See Above
License/Certification: N/A
Hiring Range*:
Greater New York City Area (NY, NJ, CT residents): $47,403 - $62,400
All Other Locations (within approved locations): $41,101 - $60,320
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.