Field Service Agent - Manhattan - Spanish

HFMS HF Management Services, LLC; New York (NY); On-site; USD 42,000 - 66,000; Full time

Job summary

Healthfirst is seeking a Field Service Agent to act as an in-person liaison with members and providers. You will assist with insurance questions, applications, and claims, address inquiries, and help resolve issues in a timely manner.

The role requires delivering high-quality customer service, de-escalating conflicts, and educating clients while adhering to HIPAA standards. Weekend events and cross-functional collaboration are part of the responsibilities.

Qualifications

• 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

Responsibilities

• Provide high-quality customer service to providers and members across all LOBs with questions on eligibility, benefits, claims process, escalations, and products
• Manage face-to-face encounters to provide information, improve member experience, and reduce waiting time
• Identify and de-escalate dissatisfied member/provider scenarios and provide satisfactory resolutions
• Build sustainable relationships of trust through open and interactive communication with internal and external customers
• Provide ad-hoc assistance to cross-functional teams on campaigns and case reviews to ensure standards are met
• Partner with Healthfirst member-facing departments by participating in community events to engage and educate members
• Comply with HIPAA requirements and maintain PHI confidentiality across data
• Assist with weekend responsibilities at Healthfirst Community Offices or events
• Initiate investigations and participate in root cause analysis to drive process improvements

Skills

Customer service

Conflict resolution

Active listening

Communication skills

Multitasking

Education

Associate degree or equivalent

Tools

Excel

Word

Outlook

Job description

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.

Job Description

• - Duties/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

Minimum Qualifications:

• - 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

Preferred Qualifications :

• - 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)

Compliance & Regulatory Responsibilities : See Above
License/Certification: N/A

Hiring Range*:

• - Greater New York City Area (NY, NJ, CT residents): $48,600 - $65,960
• - All Other Locations (within approved locations): $42,200 - $62,400

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.

Know Your Rights

All hiring and recruitment at Healthfirst is transacted with a valid "@healthfirst.org" 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 @healthfirst.org, 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): $48,600 - $65,960
• - All Other Locations (within approved locations): $42,200 - $62,400

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.