Patient Relations Call Center Representative-NYC (109735) | Actors Fund

Patient Relations Call Center Representative-NYC

Call Center Representative primary responsibilities include answering customer calls, proactively working to resolve members and providers questions & concerns, responding to and documenting all customer encounters, intaking complaints, conducting outreach and retention efforts, assisting with PCP selections and handling all provider inquiries related to eligibility, claims and authorizations.

Core Responsibilities: 

  • Strive for first call resolution, working to resolve member and provider issues at the point of contact
  • Utilize dual monitors and leverage computer-based resources to find answers to customer questions
  • Research and respond accurately to all customer inquiries related to eligibility, benefits/ services, claims and authorizations
  • Classify and record all customer encounters clearly and concisely
  • Identify and escalate complex issues and provide follow-up/ closure
  • Identify and intake customer complaints capturing all pertinent information
  • Assist members with PCP selection, as well as, locating providers and vendors within Plan’s network
  • Verify and update member demographic information
  • Process requests for member materials, such as ID cards, member guide, provider directory, etc
  • Handle enrollment inquiries and generate sales leads
  • Handle disenrollment requests and pro-actively conduct retention efforts
  • Perform outreach related to New Member Orientation and PCP Term/ Resign projects
  • Process premium payments
  • All other duties and special projects as assign by the Director of Customer Services
  • Ability to work between 8:00AM and 8:00PM Monday – Friday, and 9:00AM-5:00PM Saturday
  • Training class (Paid): 9:00AM-5:00PM Monday-Friday

Required Skills: 

  • High School graduation or evidence of having satisfactory passed a High School Equivalency Program
  • Minimum 1 year experience in a call center environment or a satisfactory equivalent combination of education, training and experience
  • Proven experience in providing excellent service to customers in various healthcare related areas, (i.e. insurance, doctor’s office, medical clinics)
  • Poise under pressure when dealing with difficult situations and potentially upset customers
  • Ability to work in a fast-paced environment while keeping a high attention to detail

Position Type: 


City & State: 

Brooklyn, New York

Start Date: 


Position Length: 


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Applicant Review Requirements: 


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