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Member Experience Representative I

Job Ref: 58487
Category: Member Services
Location: 160 Water St. #3, New York, NY 10038
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $45,000.00
Salary Range: $45,000.00 - $45,000.00

About NYC Health + Hospitals

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 Member Experience Operations Department is responsible for the timely recertification and securing of the active membership within MetroPlus Health Plan. The Member Experience Representatives are responsible for assisting members with their recertification process/applications in person and/or by phone. The Member Experience Representative must ensure timely, effective and efficient outreach in order to sustain membership. This includes both in-house and external outreach.

Job Description

  • Assist all lines 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 due to recertify.
  • Communicate the managed care concept and the importance of continuity, as well as promote and educate consumers about the importance of renewing their Health Care Coverage.
  • Establish and maintain an accurate record of all member contact. This includes but is not limited to telephone outreach, walk-ins and appointments.
  • Accurate completion and timely submission of hardcopy renewal applications, necessary forms, transmittals and batch sheets.
  • When requested or desired by the member, support the timely NYSoH (Marketplace) renewal completion.
  • Timely collection of outstanding documents to complete pending/incomplete renewal applications for both hardcopy and NYSoH (Marketplace) enrolled members.
  • Participation of renewal events aimed at attracting hard to reach members for assistance.
  • Maintain/Increase daily Outreach and Renewal goals set to increase overall

Minimum Qualifications

  • High School graduation or evidence of having satisfactorily passed a High School Equivalency Program; and,
  • Demonstrated skills in written and oral communication which includes but is not limited to an internal individual assessment test
  • Minimum one year of experience in direct consumer contact, sales and/or social services; or,
  • A satisfactory equivalent combination of education, training and experience.
  • Two years or more of experience in direct consumer contact, sales and/or social services preferred.
  • Prior Managed Care Experience preferred.
  • Community/Field experience is preferred.
  • Bilingual in a second language is preferred.
  • Bachelor’s degree preferred.

Professional Competencies

  • Integrity and Trust
  • Customer Focus
  • Functional/Technical skills
  • Written/Oral Communication
  • Computer literacy in Microsoft Outlook or equivalent, Excel and Word.