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As we empower every New Yorker
to live the healthiest life possible.

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Job Details

Customer Services Representative I

Job Ref: 46325
Category: Member Services
Location: New York, NY
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $41,985.00
Salary Range: $41,985.00 - $41,985.00

Marketing Statement

MetroPlus Health Plan 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, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. 

Position Overview

The Customer Services 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, conduct outreach efforts, assist in PCP selection, conduct new member orientations, claims review inquiries, handle provider and utilization management inquiries, etc. 

Job Description

  • Record and respond to all Customer contacts and update in 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.
  • Process and resolve complaints and record given information in the system. 
  • Assist members with the selection and assignment of PCP’s. 
  • Update all member demographic changes. 
  • Provide all benefit/service related information to members, perspective members and providers.
  • Perform retention efforts for all lines of business.
  • Handle roster Inquiries 
  • Handle disenrollment inquiries from members, providers and regulatory agencies.
  • Handle provider inquiries.
  • Schedule marketing appointments for prospective enrollees 
  • Respond to all claim billing inquiries from providers and members
  • All other duties and special projects as assigned by Associate Executive Director

Minimum Qualifications

  • High School graduation or evidence of having satisfactory passed a High School Equivalency Program; and 
  • Minimum 1 year experience in a call center environment or a satisfactory equivalent combination of education, training and experience.
  • Proven experience in providing excellent service to customers 

Professional Competencies

  • Integrity and Trust
  • Customer Focus
  • Functional/Technical skills
  • Written/Oral Communication