claims adjuster

sales representative

order picker

care manager

senior sales representative

MetroPlusHealth

Employees deserve a work environment where they feel safe while contributing to an organization’s growth and success. Unfortunately, MetroPlus’ culture of bullying and discriminatory practices are infectious and do not promote a healthy work environment. Workplace  inefficiencies and poor service delivery systems are common place in the organization and quality employees struggle with making a decision to remain with the organization for any significant periods of time. MetroPlus continues to have difficulties with provider satisfaction because of broken and antiquated processing systems and a lack of firm, evidenced based senior leadership directives. Service Representatives find it challenging to perform basic functions of researching and explaining incorrect claim denials and underpayments. Senior leadership is focused on call answer rates from inadequately staffed units, poorly organized workflows and a claims auditing process with no purposeful goal. The focus has never been on proactively resolving front end claim errors and adapting similar business models of successful competitors. Other health plans are therefore leveraging MetroPus’ inadequacies to gain a  stronger foothold in the marketplace. 
As a final note of caution, should you decide to brave the waters and consider employment at MetroPlus, stay away from choosing their commercial product, MetroPlus Gold, as your health plan. Employees who enroll in MetroPlus’ commercial product risk exposure of sensitive claim information because claims are handled by other MetroPus employees!

Pros: Benefits, Steady Schedule, Coworkers
Cons: Management, Pay Scale, Culture

On paper, MetroPlus seems like a great place to be employed given the benefits and the overall difficulty of the job. As a sales representative, I never found the work to be overly challenging (despite the current goal of 7 enrolled members a day). However, management makes things more of a challenge than they need to be and often times can even prevent you from properly completing your work, especially when they micromanage their employees. Alongside strict deadlines and a lack of support from your superiors, MetroPlus makes it clear that you’re easily replaceable. The quantity of work is not equal to the level of pay. They claim to have various growth opportunities and say they promote from within but ultimately you’ll start to realize that people are promoted based on favoritism/nepotism than their actual ability. When speaking out on any of the company’s practices many just turn a blind eye or worse more you're terminated for your criticisms. Work is based on volume and not quality. As a representative you are expected to go above and beyond for the company while management doesn’t even do the bare minimum for you to work properly, let alone succeed. Overall and simply put, MetroPlus gets in their own way in terms of growing the company. Management is completely out of touch and blames its employees when something goes wrong instead of taking accountability. I highly advise anyone that’s looking for employment here to look elsewhere. Before I close out, I want to add that it’s not like there aren’t any benefits to working here but, the severe challenges make it so that the pros are almost non-existent.

Potential to be the best job ever.  However the Company do not like investing in competitive benefits packages to sell the clients.  Too many internal rivalries among departments.  Shady HR/ Labor relations that provides information that is not correct.  Do not help employees, allows management mistreat employees specially if do not belong to a union and do not do anything about it because of internal friendships that they have with department heads.  A marketing management that blame sale associates, supervisor and managers for the bad products they sell.  Marketing department leadership with big head and that harasses their staff and think it is ok because HR look the other way.  A case management department that is not accountable.  A provider relations department that do not recruit doctors based on opportunities and needs for the Company.  Low morale specially in departments that oversee smaller products due to the lack of support from upper management and executive staff.  The company wants to have a diverse product offerings However they don't invest in products that make sense for the clients.  Very unprofessional Company with department heads that discusses employee personal information in front of whomever.  Old payroll system. Executives having love relashionships with members of their staff and HR/ Labor relations looking the other way because of their friendships with the department heads.  This company do not give merit increases, and if they do you have to wait 10 years to get it.  Surprised this company is not under investigation for their illegal practices and broken processes.

During my time at MetroPlus Health, I found the work-life balance to be one of the few positives. However, I experienced challenges related to structure, leadership, and innovation. Many projects lacked clear timelines and consistent direction. There was frequent turnover in guidance, and goals often changed or were delayed without explanation.

Initiatives were approached on a case-by-case basis, which created a reactive rather than proactive environment. In my experience, project accountability was limited, and taking ownership could sometimes be met with resistance. There was minimal investment in process improvement or internal development, and reliance on external vendors appeared to take precedence over growing internal technical staff.

The culture among departments felt siloed, and collaboration was inconsistent. Communication gaps were common, and newer employees—especially during probation—may find limited support or clarity in expectations. Career advancement and modern tooling (such as automation or improved reporting) were limited during my time. That said, some highly skilled analysts and technical staff worked hard and were a highlight of the organization.

This role may suit individuals looking for work-life balance, but those seeking clear project goals, mentorship, or technical innovation might find it more challenging.

Since I held two different titiles while employed with Metroplus i will start off with my first position as a TAP Outreach Worker. TAP stood for treatment adherance program which meant we were responsible for outreaching to individuals that were infected with HIV/Aids that were not complying with there doctors visits. I was provided with a list of individuals that I was responsible on contacting them, getting them to agree that I could schedule a medical appoitment for them and then escorting them. Once those individuals kept three consecutive appointments there case with me was closed. I learned that you can not be gental all the time, that in some cases you have to be as blunt and forth coming to some and they would respect you more for your honesty. The hardes part of the job was when you would lose a person you were working with.

As a marketing representative I still worked with the HIV/Aids population but I was responsible for trying to get them to enroll in a managed care plan which was not easy since they had Medicaid and Medicaid to them was like having a gold card you could go anywhere. The most enjoyable part of the job I worked in a hospital and met a lot of people. My co-workers were easy to work with, we all worked in different parts of the hospital or city so it was a great way to network.

Some staff are really nice, however the environment has shifted where everyone wants to protect themselves. Constant turn over and no respect for staff. Upper management seems unaware of what staff actually does on a daily basis and they have unrealistic expectations. Areas are miss aligned, restructuring is needed, however management confuses restructuring with the need for layoffs and replacement.  The impossible or unrealistic is asked and expected.  Communication is horrible.  Changes are instituted and immediate outcomes are expected.  Some staff are over burdened and others don’t have enough to do.  Clear expectations are not set out.  The current CEO has some very good ideas, however how she goes about instituting them is flawed.  Some may say if your good at your job you have nothing to fear, however you get the sense your every move is watched and anything perceived as error is grounds for termination no true building up of staff.  Some are thrown into positions without proper resources or support, its almost as if one is being set up to fail.  Everyone seems to protect themselves and are fearful to admit if they are unsure of something or if they did something wrong; instead many turn to a game of blame and pin it on someone else. It came from a place that was beyond lax and need to get its act together to a place of chaos and confusion.

Metro Plus Health Plan, Inc. is a health services plan, wholly owned subsidiary of the New York City 
Health and Hospitals Corporation (HHC). In addition to Medicaid Managed Care, Metro Plus offers Child Health Plus, Family Health Plus and several Medicare Advantage Plans and a Special Needs Plan (SNP) for people with HIV and their families. The project was about migration of data from MS SQL server 2005 database to MS SQL server 2008R2 database and maintenance of the database to enhance system performance. Reports were delivered using SSRS based on the cube created on SSAS for insurance claims analysis.
 the data source and the data source views.
	Created SSIS packages using different talks and transformations and moved data from various sources to appropriate destinations.
	Provide error handling to SSIS packages to make the package flow smoother.
	Fetch the data from different data feeds, load it into destinations and perform some polishing transformation to SSIS package and hence complete the ETL process.
	Developed Dashboards on SharePoint using SSRS for Business Intelligence usage in Enterprise Data Warehouse.
	Provide security to the reports created in SSRS.
	Generated Daily, Weekly and Monthly Trigger based reports regarding assigned projects to designated Managers and Clients.

This has been one of the worst places that I have ever worked in my professional career. Mid to upper management lacks compassion, transparency, professionalism, communication, they are a closed mind group. There is so much nepotism in the work place & it is very obvious who are the teacher's pet. There is little or no flexibility (only applies to certain people who have ‘special’ accommodations). 

If you’re not in your chair sitting and staring at your computer, then you’re not working hard. Usually projects gets off to a good start, then abruptly ends without any valid explanation. The work gets overshadowed by silly noncompliance issues. People come and go - revolving door. I quickly learned if they don’t like you they will try to build a case against you or harass you until you call it quits.  

The Human Resources department is incompetent - do not go there to make a formal complaint it will go nowhere and will come back to hunt you. There is no confidentiality. 

It is very obvious that certain people have privileges they do as they please. Spies everywhere so be cautious. 

I cannot stress enough that this is a horrible, hostile, cutthroat environment. They do not value your opinion or ideas you bring to the table. If you’re not part of the ‘in crowd’ then you won’t succeed here.

Worked with case management in HIV services for high-risk members that qualify for SNP (Special Needs Plan) in Medicare and Medicaid.
• I learned skills such as data entry and consolidation by preparing for an upcoming Medicare audit in the fall, verifying the current members' statuses to see whether they still qualify for Medicare. I worked in a team with two other interns as we reviewed cases for each of MetroPlus's thousands of members under the SNP. I learned how to navigate large data sets with programs such as PowerSTEPP and DCMS, which involved cooperating with other departments such as Claims, MIS, and Network Relations.
• One of my biggest projects entailed data analysis of various pharmacies, prescribers, and Rx drugs. Given my unique background in statistics, I proposed strategies on predictive modeling of the high-risk population and defining that threshold based on different variables. At the end, we were able to develop a system to sort through over a million prescriptions and immediately identify frequent abusers and fraudulent prescribers with the help of Access, which I used to model the data into relevant information.

What is the best part of working at the company?
The knowledge gained in the area of Behavioral Health that I didn’t know , also the workforce activities They have in helping the Inner Communities.  

What is the most stressful part about working at the company?
The wanting to make a difference with EVERY CASE OR CLIENT and sometimes Unfortunately we can ONLY do what is permitted by the CityLimits   

What is the work environment and culture like at the company?
A Diverse group of people with a common goal to HELP people , mixed in with a Fun but diligent group of multicultural people who bring a vast experience of their culture and ideas to the work space. However, always keeping the main idea and objective of the Company and that’s to Grow towards a Healthier Environment . By meeting in a timely fashion,  beating deadlines and putting plans in place to create Programs that Innovate and enhance the clients we work for.  

What is a typical day like for you at the company?
A fast paced  work place that is constantly bubbling with ideas , plans, and activities . Serviced by a multicultural employees full of optimism, along with a few of your Angry Birds in the AM 😄.

Top Job Titles	Average Salary
Claims adjuster 1 salary reported	$49,797 per year
Sales representative 3 salaries reported	$56,667 per year
Order picker 10 salaries reported	$30.06 per hour
Care manager 1 salary reported	$95,000 per year
Senior sales representative 4 salaries reported	$60,000 per year

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