Description and Requirements
The Service Agent is responsible for supporting Contact Center Operations (CCO) by ensuring members and/or providers receive an exceptional customer experience. This individual receives and addresses member & provider inquiries, resolves complaints, educates clients, retains members, helps to prevent dis-enrollments, and escalates issues requiring additional intervention across all Lines of Business (LOBs) within our traditional and/or Omni-channel contact center environment. The Service Agent maintains the Healthfirst culture and drives improvements to ensure the best possible customer experience, for our North Star Members and the Providers who service them.
Duties and Responsibilities
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- 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.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.
If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC.
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