Medicare Customer Services Representative II

$52,477 - $52,477/Yr

Metroplushealth - New York, NY

Full-time - Entry Level

New York, NY

About the position

The Medicare Customer Services Representative II is responsible for delivering high-quality service to customers, primarily focusing on Medicare-related inquiries and support. This role involves documenting customer interactions, processing complaints, assisting with provider selection, and conducting orientations for new members. The representative will be trained in the Medicare line of business and will work to resolve member and provider issues efficiently.

Responsibilities

• Document all customer contacts into the tracking system.
• Process complaints and conduct outreach efforts.
• Assist in Primary Care Provider (PCP) selection.
• Conduct new member orientation.
• Review claims inquiries and handle provider and utilization management inquiries.
• Assist management staff with special projects, such as claims review.
• Record and respond to all customer contacts and ensure appropriate follow-up and closure.
• Provide on-site and telephone orientations to new and existing members.
• Strive for first call resolution for member and provider issues.
• Utilize dual monitors and computer-based resources to find answers to customer questions.
• Research and respond accurately to customer inquiries related to eligibility, benefits, services, claims, and authorizations.
• Classify and record all customer encounters clearly and concisely.
• Identify and escalate complex issues, providing follow-up and closure.
• Intake customer complaints and capture all pertinent information.
• Assist members in locating providers and vendors within the Plan's network.
• Verify and update member demographic information.
• Process requests for member materials, such as ID cards and provider directories.
• Maintain access to all programs necessary for completing tasks as a Medicare CS Rep.
• Stay timely with ANOC, Compliance, and all necessary yearly trainings.
• Perform other duties and special projects as assigned by the Director of Call Center Operations.

Requirements

• High School diploma or GED required.
• Minimum 2 years' experience in a call center environment handling a high volume of calls required.
• Prior managed care experience preferred.

Nice-to-haves

• Experience in communication skills.

Benefits

• Paid training class from 9:00AM-5:00PM Monday-Friday.
• Hybrid work environment.