Full Job Description
MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
The Customer Services Representative provides comprehensive customer service to members, providers and prospective members. The primary responsibilities include but are not limited to documenting all customer contacts into the tracking system, process complaints, conduct outreach efforts, assist in PCP selection, conduct new member orientations, claims review inquiries, handle provider and utilization management inquiries, etc.
Record and respond to all Customer contacts and update in tracking system. Manage and ensure appropriate follow-up and closure for all customer contacts.
Provide on-site as well as telephone orientations to new and existing members.
Process and resolve complaints and record given information in the system.
Assist members with the selection and assignment of PCP’s.
Update all member demographic changes.
Provide all benefit/service related information to members, perspective members and providers.
Perform retention efforts for all lines of business.
Handle roster Inquiries
Handle disenrollment inquiries from members, providers and regulatory agencies.
Handle provider inquiries.
Schedule marketing appointments for prospective enrollees
Respond to all claim billing inquiries from providers and members
All other duties and special projects as assigned by Associate Executive Director
High School graduation or evidence of having satisfactory passed a High School Equivalency Program; and
Minimum 1 year experience in a call center environment or a satisfactory equivalent combination of education, training and experience.
Proven experience in providing excellent service to customers
Integrity and Trust