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, etc.
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-escalate 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 and follow-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, and 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.

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

CCO Service Agent, Bilingual

Key skills