Consumer Service Operations Representative

Profile

Job Information

Humana

Consumer Service Operations Representative

in

Albany

New York

Description

The Consumer Service Representative 3 will focus on membership retention of current and new members by providing local proactive 'high touch' outreach and enhanced member experience.  This role includes functions relative to benefits, enrollment and eligibility, member support, claims interpretation and processing, agent support, onboarding, local agency outreach, billing issues, payments, provider questions and call center operations. The Representative will regularly exercise discretion and judgment in prioritizing requests, interpreting, and adapting procedures, processes, and techniques.

Responsibilities

This is a hybrid position - working approximately 3 days a week from home and 2 days out of a mobile Humana RV office in the Brooklyn/Bronx/Queens areas.

The Consumer Service Representative 3 will work alongside a sales Manager in a specific market by making outbound calls and proactively managing potential member dissatisfaction. The associate will focus on membership retention of current and new members by providing local proactive customer service as it relates to members plan i.e., benefits, enrollment, eligibility, billing issues, payments, provider questions. Associate will be responsible for making outbound calls as well as having the flexibility to work alongside with local sales agents and leaders.

Key Accountabilities -

Contact provider office

Contact Pharmacy

Handling of escalated issues

Communication with members, agents and managers

Interaction with peers, sale agents and leadership- Collaboration and resolution

Representatives must document and track all interactions based upon CMS guidelines, participate in interdepartmental discussions and planning and assist the Enterprise Test and Learn Committee in measuring retention impact.

Required Qualifications

1 - 2 years of customer service experience, preferably in a role focused on customer retention and resolving/preventing customer issues.

Bilingual - English and Spanish

Must live in the NYC Metro area and have ability to work from home and out of a mobile RV office

Previous inbound and/or outbound call center or related customer service experience

Aptitude for quickly learning and navigating new technology, systems, and applications

Proficient in Microsoft Office Outlook and Word 

Working knowledge of computers, or a demonstrated technical aptitude and an ability to quickly learn new systems

Preferred Qualifications

Healthcare experience and/or sales or business development

Clerical support background in a healthcare environment

Familiarity with medical terminology

Medicare experience strongly preferred

Work at Home Requirements

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

Satellite, cellular and microwave connection can be used only if approved by leadership

Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

#LI-JB2

Scheduled Weekly Hours

40

New York City Pay Range

The compensation range represents a good-faith estimate of starting pay at the time of posting and may vary based on geographic location and/or employment type. Individual pay decisions will vary based on demonstrated job-related skills such as education, experience, certifications, etc.

$44,600 - $61,250

Pay Type

Hourly

Incentive

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Company info

Humana Inc.
Website : http://www.humana.com