Field Service Agent

• 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

• 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

• 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)

medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions