Field Service Agent - Bilingual Spanish - Manhattan

The Field Service Agent acts as an in-person liaison between Healthfirst and its customers. The individual is responsible for assisting customers with issues and inquiries they may have about their insurance, applications and/or claims not paid. The Field Service Agent is also responsible for receiving and addressing member inquiries, resolution of customer complaints, client education, retention of membership and dis-enrollments.

Responsibilities

Provide high-quality customer service to providers and members across all LOBs with a variety of questions and issues on topics such as eligibility, benefits, claims process, escalations, and products; Manage face-to-face encounters by interacting with customers to provide information in response to inquiries about products and services, improve overall member experience, and reduce waiting time to expedite traffic flow; Identify and de-escalate situations where member/provider is dissatisfied and provide a satisfactory resolution; Build sustainable relationships of trust through open and interactive communication with internal and external customers; Provide ad-hoc assistance to cross functional teams working on campaigns and case reviews to ensure standards are met; Partner with other Healthfirst member-facing departments by participating in community events to engage and educate existing/prospective members; 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; Assist periodically with weekend responsibilities at Healthfirst Community Offices (CO) or other events; Initiate investigations, partner 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 timeframes; Assist with Contact Center Operations (CCO) outbound campaigns on high volume days, while meeting deliverables associated with individual and team accountabilities; Additional duties as assigned

Requirements

High School Diploma or GED equivalent from an accredited institution; Experience in a customer service environment; Experience handling escalated issues, complex situations, and interactions requiring conflict resolution, active listening skills, and empathy; Experience working in a fast-paced environment that requires handling multiple priorities simultaneously; Willing to accommodate flexible business needs (Ex: nights, weekends, holidays, alternate locations, and/or overtime with limited notice); Work experience with Microsoft Office Suite applications including Excel, Word, and Outlook; Work experience requiring effective communication verbally and in writing while demonstrating good grammar, spelling, and punctuation skills

Nice to have

Associate degree from an accredited institution or equivalent work experience; Ability to exercise independent thinking, problem solving and achieving goals; English proficient bilingual who also speaks Spanish; Basic knowledge of operational health plan departments and functionality; Knowledge and experience with a traditional and/or omnichannel contact center with emphasis in the healthcare industry, may include but not limited to KPIs, CMS/NYSOH requirements (including CMS STARS programs) and call center operations in general; Trained in multiple Healthfirst LOBs for both Member and Provider Family of Products (FOPs)

Benefits

Medical, dental and vision coverage; incentive and recognition programs; life insurance; 401k contributions (all benefits are subject to eligibility requirements)