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    Service Advocate - New York, United States - Healthfirst

    Healthfirst
    Healthfirst New York, United States

    3 days ago

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    OTHER
    Description

    The Service Advocate is responsible for supporting Contact Center Operations (CCO) by ensuring members and/or providers receive an exceptional customer experience. The Service Advocate is engaged as the primary liaison to our Signature HMO members,providing high touch support throughout the lifecycle of these member's Healthfirst journey, ensuring they and/or their providers receive an exceptional customer experience. This individual receives and addresses member & provider inquiries, de-escalates and resolves complaints, educates clients, retains members, helps to prevent dis-enrollments, and escalates issues requiring additional intervention across all Lines of Business (LOBs) and the Signature HMO product platform within our traditional and/or Omni-channel contact center environment. The Service Advocate maintains the Healthfirst culture and drives improvements to ensure the best possible customer experience as measured by First Call Resolution (FCR) and Customer Experience KPI's, for our North Star Members and the Providers who service them.

    Duties and Responsibilities

  • Provide excellent quality customer service to Signature HMO Plan Members and/or across all Lines of Business (LOBs) for members and providers with a variety of questions and issues on topics such as eligibility, benefits, claims process, escalations, and product
  • Communicate with members and providers through various channels which may include but are not limited to inbound and outbound calls, emails, or chats
  • Manage the relationship and resolution of Member inquiries with respect to all Healthfirst vendor partners in concert with or on behalf of the Member(s)
  • Meet or exceed all performance KPIs including but not limited to quality, productivity, and dependability
  • Follow established policies and procedures to ensure member and provider issues are addressed timely and accurately
  • Identify and de-escalate situations where member/provider is upset and provide a satisfactory resolution
  • Initiate investigations as required, partnering with other assigned parties to participate in root cause analysis, communicate complex information, take proactive and/or corrective measures and/or recommend solutions and methods for process improvement and follow-up on outstanding customer inquiries and complaints within defined timeframe
  • Assist with CCO inbound contacts on high volume days, while not missing any deliverables associated with their individual and team accountabilities
  • Comply with HIPAA requirements and maintain Protected Health Information (PHI) confidentiality of member, provider, medical and departmental information; adhere to local, state, federal and Healthfirst specific compliance and regulatory guidelines
  • Build sustainable relationships of trust through open and interactive communication with internal and external customers
  • Work at locations which may include office, remote, virtual and/or field offices
  • Additional duties as required
    Requirements:

  • Work a 40-hour week with a schedule assigned during the hours of 8am-8pm Monday thru Friday from April 1st to Sept 30th and Monday thru Sunday from Oct 1st to March31st, including late shifts, weekends, and/or holidays including but not limited to Christmas Eve, New Year's Eve, New Year's Day, MLK Day and as needed during unforeseen business disruptions (with limited notice at times).
  • Designate, set up and maintain a physical workspace that is separate from the main flow of home or other traffic and is safe and secure to ensure PHI and other sensitive material are protected. The designated workspace must be HIPAA and OSHA compliant as well as comply with any departmental requirements.
  • Must have Secure Internet Service Provider (ISP) with appropriate speeds and bandwidth to support the remote nature of the role, including multiple applications and systems (required) to ensure clear and consistent communication with internal and external parties (i.e. members, providers and colleagues).
  • Must have a clear and direct connection into the ISP modem (must use ethernet cable form computer to the modem). WIFI is NOT permitted.
    Minimum Qualifications:

  • High School Diploma or GED from an accredited institution
  • Healthfirst Contact Center Operations work experience
  • Work experience handling escalated issues, complex situations, & calls requiring conflict resolution
  • Work experience with all CCO-related systems (Salesforce, PEGA, TruCare, MHS, etc.)
  • Basic understanding of call center metrics including Average Handle Time (AHT), Quality, etc.
  • Experience participating in cross-functional projects and departmental initiatives related to customer/client interaction and customer service
  • Working experience in a fast-paced environment that requires handling multiple priorities simultaneously
  • Proficient in Microsoft Office Suite applications including Excel, Word, and Outlook
    .

    Preferred Qualifications:

  • Associate Degree from an accredited institution or equivalent work experience
  • Proven track record of exercising independent thinking, problem solving and achieving goals
  • Bilingual (English and Spanish, or Mandarin/Cantonese)
  • Trained in multiple Healthfirst LOBs for both Member and Provider Family of Products (FOPs)
  • Working knowledge of Microsoft Office Power Point
  • Excellent verbal and written communication and the ability to document grammatically correct emails, communications, and presentations
    Compliance & Regulatory Responsibilities: See Above

    License/Certification: N/A

    WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

    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 or calling In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

    EEO Law Poster and Supplement

    All hiring and recruitment at Healthfirst is transacted with a valid "" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not , or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

    Hiring Range:

  • Greater New York City Area (NY, NJ, CT residents): $47,403 - $62,400
  • All Other Locations (within approved locations): $41,101 - $60,320
    As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

    In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

    The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role.

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