Call Center Representative

Details

Client Name
Metroplus Health Plan

Job Type
Travel

Offering
Non-Clinical

Profession
Non-Clinical

Specialty
Customer Service Rep

Job ID
35522644

Job Title
Call Center Representative (000290)

Weekly Pay
$1255.72


Shift Details

Shift
Day - 7x5 - 09AM

Scheduled Hours
35


Job Order Details

Start Date
08/17/2026

End Date
10/24/2026

Duration
10 Week(s)


Job Description
Job Title: Customer Service Representative
Profession: Call Center Representative
Specialty: -
Duration: 10
Shift: 7 Hrs
Hours per Shift: 5x7 Hr
Experience: Minimum 1 year experience in a call center environment or a satisfactory equivalent combination of education, training, and experience.
License: None
Certifications: None
Must-Have: High School graduation or evidence of having satisfactorily passed a High School Equivalency Program. Proven experience in providing excellent service to customers in various healthcare-related areas (i.e., insurance, doctor's office, medical clinics).


Description:
The Customer Service 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 and conduct outreach efforts.
Assist in PCP selection and conduct new member orientations.
Handle claims review inquiries and provider/utilization management inquiries.
Record and respond to all customer contacts and update them in the tracking system.
Manage and ensure appropriate follow-up and closure for all customer contacts.
Provide both on-site and 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 PCPs.
Update all member demographic changes.
Provide all benefit and service-related information to members and providers.
Perform retention efforts for all lines of business.
Handle roster inquiries and disenrollment inquiries from members and providers.
Respond to provider inquiries and schedule marketing appointments for prospective enrollees.
Address all claim billing inquiries from providers and members.
Perform any other duties and special projects as assigned.
Act as a key liaison and service representative for all written provider inquiries and problem resolution.
Respond to all claim inquiries from provider site personnel including clinical staff.
Coordinate and track appropriate problem resolution activities with plan personnel in other departments.
Ensure appropriate follow-up and closure for all inquiries.
Respond to provider inquiries in writing and maintain accurate files.
Perform data entry into the system.
Make claim adjustments to correct erroneous payments.
Participate in special projects involving claim status investigations.
Resolve member bills referred from member services.
Strong customer service skills and problem-solving abilities are essential.
Must be able to handle challenging situations in a professional manner.
Excellent written and verbal communication skills are required.
In-depth knowledge of claims processing protocols and payment schemes is beneficial.
Proficiency in relevant systems is necessary.
Customer service experience is a plus.


Client Details

Address
50 Water Street

City
New York City

State
NY

Zip Code
10004


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