Customer Services Specialist

MetroPlusHealth 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, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The Customer Services Specialist will assist the Call Center Department with the handling and resolution of all customer-related issues, while serving as a liaison among departments and outside vendors as needed. This position will assist with first call resolution for escalated issues as they arise. The Customer Services Specialist will focus on increasing customer satisfaction by conducting outreach initiatives as assigned.

• Assist customers with the scheduling of baseline appointments.
• Assist customers with the scheduling of specialty appointments. Facilitate and arrange referrals for network providers and members.
• Assist members/providers with obtaining Durable Medical Equipment Services for customers
• Assist providers with claims related issues in addition and not limited to delay in payment, how to appropriately bill, billing disputes, roster related issues, enrollment and disenrollment issues, etc.
• Assist Customer Services Representatives with case management issues in addition and not limited to: Serving as a liaison for the customer with other departments and outside vendors.
• Create and manage reports detailing all productivity for each area of responsibility, as assigned. Also assist CSR’s with how to utilize systems as required, e.g.: review of processes, claims, authorizations.
• Handle all web and portal requests from customers and applicants, ensuring expeditious and appropriate handling/escalation.
• Assist with the handling of incoming emails received via the cssgroup@metroplus.org email distribution.
• Assist the CSD with the handling of assigned projects in addition and not limited to: Abandoned Call Back Project, PCP Error assignments, Health Crowd Project, Customer Satisfaction Survey Project, Restricted Recipient Related Projects
• Conduct outreach via phone call and or mail to all members with minimal use of the plan within a 6-month period, to ensure satisfaction.
• Assist the department with the handling of escalated issues as needed.
• All other duties as assigned

• High School graduation or evidence of having satisfactory passed a High School Equivalency Program; and
• Minimum 3 years’ experience in a call center environment handling high volume of calls required
• Prior managed care experience preferred

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Written/Oral Communication

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