The Performance Support Specialist will be responsible for providing assistance in resolving complaint issues escalated by the representatives. This role is required to pull non-urgent complaint reporting through various systems on a daily basis, review each matter and reach out to the member in order to provide determinations while maintain a tracking system for any and all incoming complaint issues.
Duties & Responsibilities:
- Assist in resolving customer complaints escalated by internal and external business partners as needed.
- Assist in reviewing and modifying Physician capitation reports.
- Assist in resolving member issues who called in multiple times with the same issues.
- Assist in responding and resolving escalated inquiries from other departments and external contacts.
- Make recommendations on process improvements.
- Build sustainable relationships of trust through open and interactive communication with internal and external customers.
- Able to properly follow procedures based on issues and documents received
- Make recommendations to management concerning staff performance.
- Make recommendations on process improvement.
- Maintain open exchange of information with external and internal customers.
- Required to multi-task, prioritize and manage time effectively.
- Timely filing of complaints.
- Conduct outreaches as required.
- Attend meetings as business requires.
- Additional duties as assigned.
Minimum Qualifications:
- High School Diploma or GED from an accredited institution
- Healthcare industry experience
- Experience working in customer service
- Excellent telephone & customer service skills
- Experience working in clerical or administrative capacity
- Experience meeting strict deadlines
- Proficient in Microsoft suite of applications including Word, Power point, Outlook and Excel.
Preferred Qualifications:
- Associate degree from an accredited school
- Conflict Resolution Experience
- Experience handling complex situations and/or projects
- Experience in developing and coaching of staff
Compliance & Regulatory Responsibilities: NA
License/Certification: NA
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [email protected] or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.
EEO Law Poster and Supplement
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): $47,403 - $62,400
-
All Other Locations (within approved locations): $41,101 - $60,320
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.
What We Do
Healthfirst is a provider-sponsored health insurance company that serves 1.8 million members in downstate New York. Healthfirst offers top-quality Medicaid, Medicare Advantage, Child Health Plus, and Managed Long Term Care plans. Healthfirst Leaf Qualified Health Plans and the Healthfirst Essential Plan are offered on NY State of Health, The Official Health Plan Marketplace. Healthfirst offers Healthfirst Pro and Pro Plus, Exclusive Provider Organization (EPO) plans for small-business owners and their employees, and Healthfirst Total, an EPO for individuals.
For more information on Healthfirst, visit www.healthfirst.org
