Customer Service Representative

Job Description

Job Description

Duties:
First point of contact for all customer service issues. Responsible for ensuring patient/client medications, supplies and equipment are accurately recorded and sent to distribution. Consults with Supervisors to ensure timely and accurate delivery of supplies/equipment. Maintains patient privacy and confidentiality at all times according to established procedures. Provides positive, supportive communication to supervisor, patients, families, visitors and company personnel.
The Customer Success Specialist I is responsible for supporting MetroPlusHealth members and other key stakeholders across the customers journey. They are expert on the system and understand the NYSOH processes to quickly route members to the appropriate resolution and support.
The Customer Success Specialist I works as a liaison to ensure proper processes are introduced and implemented such that the MetroPlusHealth experience is enhanced. The Customer Success Specialist I provides excellent customer experience, ultimately resulting in member retention through both inbound and outbound outreach. The Customer Success Specialist I is responsible for overseeing all aspects of member retention and being a single point of contact across all issues that are directed to the Customer Success department.
Scope of Role & Responsibilities (URAC Core 25d)

Recertification/Renewal of Membership:
Assist all line of business (Medicaid/Medicare/MLTC/CHP/EP) in retaining current qualified members by following a strategic daily work schedule that includes am and pm hours as well as weekends. This is designed to optimize telephone outreach with members who are due to recertify.
Follow appropriate processes to meet and exceed recertification targets set by the department
Make the recertification process as easy and seamless as possible for our members
Assist members with completion of recertification applications
Partner with different parts of the organization to understand any barriers to the members experience and work to resolve them appropriately
Meet daily outreach and renewal goals that contribute to overall member retention for the organization

Enrolment and Retention Support:
Assist members with completion of all enrolment activities including but not limited to changing lines of business to ensure member is in the optimal plan, re-enrolling members due to administrative issues, premium payment, etc.
Assist members with PCP selection as well as locating providers and vendors within the Plans network
Provide end-to-end customer support to drive customer satisfaction and improve customer experience
Interface with internal and external stakeholders to ensure complete resolution
Communicate verbally and in writing with members for all necessary member retention activities

Process Improvement:
Devise solutions in response to member dissatisfaction/complaints/issues in support of ongoing organizational improvement efforts
Support any ad hoc projects on process improvements
Report common trends identified during member outreach

Skills:
One year experience

Education:
High School Diploma/GED

Languages:
English

Certifications & Licenses:
Certified Application Counselor