Field Service Agent - Manhattan - Spanish

healthfirst; New York (NY); On-site; USD 49,000 - 66,000; Full time

Job summary

Healthfirst in New York is seeking a Field Service Agent to serve as the in-person liaison with members and providers. You will assist with insurance inquiries, applications and claims, resolve issues, and educate members to support retention and enrollment decisions.

You will handle escalated inquiries, de-escalate conflicts, and collaborate with cross-functional teams while complying with HIPAA and privacy standards. Weekend coverage may be required at community offices or events.

Qualifications

• High School Diploma or GED or equivalent required.
• Experience in a customer service environment.
• Experience handling escalated issues and conflict resolution.
• Experience in a fast-paced environment with multiple priorities.
• Willing to accommodate flexible schedule including nights, weekends, holidays and overtime.
• Proficiency with Microsoft Office including Excel, Word and Outlook.
• Strong verbal and written communication with good grammar and punctuation.

Responsibilities

• Provide high-quality customer service to members and providers across inquiries on eligibility, benefits, claims, and products.
• Manage face-to-face encounters to inform and respond to questions, improving member experience.
• Identify and de-escalate dissatisfied situations and provide satisfactory resolutions.
• Build trusted relationships through open communication with customers.
• Provide ad-hoc cross-functional support for campaigns and case reviews.
• Collaborate with Healthfirst departments by participating in community events to engage members.
• Comply with HIPAA and protect PHI per guidelines and regulatory requirements.
• Assist with weekend responsibilities at Healthfirst Community Offices or events.
• Initiate investigations and contribute to root cause analysis for process improvements.
• Support Contact Center Operations outbound campaigns on high-volume days.
• Perform additional duties as assigned.

Skills

Customer service

Conflict resolution

Active listening

Multitasking

Professional communication

Bilingual English/Spanish

Education

High School Diploma or GED

Associate degree (preferred)

Tools

Microsoft Excel

Microsoft Word

Microsoft 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

• 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.