Role Description The Service Agent is responsible for supporting Contact Center Operations (CCO) by ensuring members and/or providers receive an exceptional customer experience. This individual receives and addresses member & provider inquiries, resolves complaints, educates clients, retains members, helps to prevent dis-enrollments, and escalates issues requiring additional intervention across all Lines of Business (LOBs) within our traditional and/or Omni-channel contact center environment. The Service Agent maintains the Healthfirst culture and drives improvements to ensure the best possible customer experience for our North Star Members and the Providers who service them. Duties and Responsibilities - Provides excellent quality customer service to our members and/or providers relating to all aspects of member/provider questions and issues such as eligibility, benefits, claims process, escalations, and product questions. - May include but is not limited to inbound/outbound calls/emails/chats, onsite/remote/virtual/field location, on behalf of CCO. - Meets/Exceeds all performance KPIs including but not limited to quality, productivity, and dependability. - Follows established policies and procedures to ensure member and provider issues are addressed timely and accurately. - Identifies and de-escalates situations where member/provider is upset and provides resolution for their issue. - Initiates investigations as required, partnering with other assigned parties to participate in root cause analysis, takes proactive and/or corrective measures and/or recommends solutions and methods for process improvement. - Follows up on outstanding customer inquiries and complaints within defined timeframe. - Complies with HIPAA requirements and maintains Protected Health Information (PHI) confidentiality of member, provider, medical and departmental information. - Adheres to local, state, federal and Healthfirst specific compliance and regulatory guidelines. - Builds sustainable relationships of trust through open and interactive communication with internal and external customers. - Works a flexible schedule including a late shift, weekends, and/or holidays (with limited notice at times), and as needed during unforeseen business disruptions. - Additional duties as required. Qualifications - High School Diploma or GED from an accredited institution. - Prior experience in a customer service environment. - Experience participating in cross-functional projects and departmental initiatives related to customer/client interaction and customer service. - Working experience in a fast-paced environment. - Proficient in Microsoft Office Suite applications including Excel, Word, and Outlook. Requirements - Associate’s or Bachelor’s Degree from an accredited institution or equivalent work experience. - Proven track record of exercising independent thinking, problem solving and achieving goals. - Knowledge and experience with a traditional and/or omnichannel contact center with emphasis in the healthcare industry. - Experience navigating multiple technologies including a Customer Relationship Management System. - Basic knowledge of operational health plan departments and functionality. - Working knowledge of Microsoft Office Power Point. - Excellent verbal and written communication and the ability to document grammatically correct emails, communications, and presentations. - Basic understanding of call center metrics including Average Handle Time (AHT), Quality, etc. Benefits - Medical, dental and vision coverage. - Incentive and recognition programs. - Life insurance. - 401k contributions (all benefits are subject to eligibility requirements). - Competitive compensation and benefits package wherever its employees work and live. Company Description WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798. Know Your Rights: All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company.