Customer Service Specialist II

2 months ago

New York, New York, United States NYC Health Hospitals Full time

About NYC Health + Hospitals
NYC Health + Hospitals is dedicated to delivering exceptional healthcare services to the diverse communities of New York City. Our organization encompasses a wide range of healthcare programs, including Medicaid Managed Care, Medicare, and various other health initiatives aimed at improving the well-being of our residents.

Position Overview
The Customer Service Specialist II plays a vital role in ensuring high-quality service delivery to our members. This position involves documenting customer interactions, addressing complaints, assisting with provider selection, and conducting orientations for new members. In addition to Level I responsibilities, the Specialist II will support management and escalate issues as necessary.

Key Responsibilities

  • Assist management with special projects, including monthly provider assignments and error reports.
  • Document and respond to all customer interactions, ensuring proper follow-up and resolution.
  • Conduct both in-person and phone orientations for new and existing members.
  • Aim for first-contact resolution by addressing member and provider inquiries effectively.
  • Utilize technology and resources to provide accurate answers to customer questions.
  • Research and respond to inquiries regarding eligibility, benefits, claims, and authorizations.
  • Clearly classify and document all customer encounters.
  • Identify and escalate complex issues while ensuring follow-up and resolution.
  • Capture and document customer complaints with all relevant details.
  • Assist members in selecting primary care providers and locating services within the network.
  • Verify and update member demographic information as needed.
  • Process requests for member materials, including ID cards and provider directories.
  • Manage enrollment inquiries and generate leads for potential sales.
  • Handle disenrollment requests and engage in retention efforts.
  • Conduct outreach related to new member orientations and provider terminations.
  • Process premium payments efficiently.
  • Perform additional duties and special projects as assigned by management.
  • Availability to work flexible hours, including evenings and weekends.
  • Participate in a paid training program.
Minimum Qualifications
  • High School diploma or equivalent.
  • A minimum of three years of experience in a high-volume call center environment.
  • Demonstrated experience in providing excellent customer service in healthcare settings.
  • Ability to maintain composure in challenging situations with upset customers.
Professional Competencies
  • Integrity and Trust
  • Customer Focus
  • Technical Proficiency
  • Effective Communication Skills
  • Attention to Detail in a Fast-Paced Environment

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