Medicare Customer Services Representative II

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

The Medicare Customer Services Representative II (Medicare CS Rep) is responsible for providing comprehensive high-quality service to all customers. 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 orientation, review claims inquiries, handle provider and utilization management inquiries, etc. The Medicare Customer Services Representative will be trained in the Medicare line of business.

• Assist management staff with special projects: i.e., Claims Review
• Record and respond to all customer contacts and update 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 for lines of business that you are trained on.
• 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 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.
• Maintain access to all program necessary for completing tasks of a Medicare CS Rep.
• Stay timely with ANOC, Compliance, and all other necessary yearly trainings.
• All other duties and special projects as assign by the Director of Call Center Operations.
• Ability to work between 8:00AM and 8:00PM Monday - Friday, and 9:00AM-5:00PM Saturday
• Training class (Paid): 9:00AM-5:00PM Monday-Friday

• High School graduation or evidence of having satisfactory passed a High School Equivalency Program; and
• Minimum 2 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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