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Customer Services Representative I ID-1113

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health + Hospitals

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, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

Customer Service Representatives (CSRs) are responsible for providing comprehensive high-quality service to all customers. The primary responsibilities, include but are not limited to, answering customer calls, proactively working to resolve our members and providers questions and concerns, responding to and documenting all customer encounters, intaking complaints, conducting outreach and retention efforts, assisting with Primary Care Provider (PCP) selections and handling all provider inquiries related to eligibility, claims and authorizations.

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Job Description

  • Strive for first call resolution, working to resolve member and provider issues as the point of contact
  • Utilize dual monitors and leverage computer-based resources to find answers to customer questions
  • Research and respond accurately to all customer inquiries related to eligibility, benefits/services, claims and authorizations.
  • Classify and record all customer encounters clearly and concisely.
  • Identify and escalate complex issues and provide follow-up/closure.
  • Identify and intake customer complaints capturing all pertinent information.
  • Assist members with PCP selection, as well as, locating providers and vendors within plan’s network.
  • Verify and update member demographic information.
  • Process requests for member materials, such as ID cards, member guide, provider directory, etc.
  • Handle enrollment inquiries and generate sales leads.
  • Handle disenrollment requests and pro-actively conduct retention efforts.
  • Perform outreach related to New Member Orientation and PCP term/reassign projects.
  • Process premium payments.
  • All other duties and special projects as assign by the Director of Customer Service.
  • Ability to work between 8:00 AM and 6:00 PM Monday - Friday, and 9:00 AM-5:00 PM Saturday.
  • Training class (Paid): 9:00 AM-5:00 PM Monday-Friday.

Minimum Qualifications

  • 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.
  • Managed care experience preferred.
  • Proven experience in providing excellent service to customers in various healthcare related areas, (i.e., insurance, doctor’s office, medical clinics).
  • Poise under pressure when dealing with difficult situations and potentially upset customers.
  • Ability to work in a fast-paced environment while keeping a high attention to detail.

Professional Competencies

  • Integrity and Trust
  • Customer Focus
  • Functional/Technical Skills
  • Written/Oral Communication
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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

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