Essential Duties and Responsibilities:
- Interface with clients and refer complaints or inquiries to appropriate departments, agencies, advocates, or client representatives.
- Stay updated on managed care relevant to supported client programs.
- Adhere to processing guidelines, protocols, and contract requirements for complaint processing and handling PHI/PII.
- Assist consumers in health plan enrollment, disenrollment, and transfers when necessary.
- Fulfill assigned duties directed by the Complaint Unit Supervisor or Project Management.
- Meet performance standards outlined in the annual criteria and bonus template for the position.
- Address complex customer service inquiries and problems over the telephone, noting consistent issues for resolution.
- Potentially respond to email inquiries.
- Prioritize customer service as the primary function, handling non-routine calls requiring deviation from standard procedures.
- Manage situations needing adapted responses or extensive research based on customer needs.
- Utilize computerized systems for tracking, information gathering, and troubleshooting.
- Handle escalated or unresolved calls from less experienced representatives.
- Tackle moderately difficult assignments, exercising judgment in issue resolution and recommending solutions.
- Maintain updated knowledge of managed care as it relates to client supported programs.- Meet the established processing guidelines, protocols and contract requirements related to complaint processing and the handling of PHI/PII.- Perform other duties as may be assigned by the Complaint Unit Supervisor and/or Project Management.- Meet all standards established for this position as outlined in the corresponding annual performance criteria and bonus template for this position.- Handles more complex provider inquiries and problems via telephone, recording consistent problem areas. - May respond to email inquiries. - Calls are non-routine and require deviation from standard screens, scripts, and procedures.- Handles situations which may require adaptation of response or extensive research according to customer response.- Uses computerized system for tracking, information gathering, and/or troubleshooting. - May handle escalated or unresolved calls from less experienced representatives.- Works on assignments that are moderately difficult, requiring judgement in resolving issues. - Understands implications of work and makes recommendations for solutions. - Demonstrates strong attention to detail to ensure accuracy and thoroughness in all tasks and documentation.- Follows established guidelines and directions while maintaining a proactive approach to meeting objectives and deadlines.- Effectively manages multiple tasks and priorities under pressure, ensuring high-quality outcomes in a fast-paced environment.- Performs other duties as assigned by management
Minimum Requirements
- High school diploma or GED required and 1+ years of relevant professional experience required, or equivalent combination of education and experience.
Preferred Requirements- Experience working with NYSOH Marketplace or medical billing.
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EEO Statement Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics. Pay Transparency Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances.