CCO Service Agent - Remote

The Service Agent is responsible for supporting Contact Center Operations (CCO) by ensuring members and/or providers receive an exceptional customer experience. This individual receives and addresses member & provider inquiries, resolves complaints, educates clients, retains members, helps to prevent dis‑enrollments, and escalates issues requiring additional intervention across all Lines of Business (LOBs) within our traditional and/or Omni‑channel contact center environment. The Service Agent maintains the Healthfirst culture and drives improvements to ensure the best possible customer experience for our North Star Members and the Providers who service them.

• Provides excellent quality customer service to our members and/or providers regarding all aspects of member/provider questions and issues such as eligibility, benefits, claims process, escalations, and product questions. May include but is not limited to inbound/outbound calls/emails/chats, onsite/remote/virtual/field location, on behalf of CCO.
  • Meets/Exceeds all performance KPIs including but not limited to quality, productivity, and dependability.
  • Follows established policies and procedures to ensure member and provider issues are addressed timely and accurately.
  • Identifies and de‑escalates situations where member/provider is upset and provides resolution for their issue. Initiates investigations as required, partnering with other assigned parties to participate in root cause analysis, takes proactive and/or corrective measures, and/or recommends solutions and methods for process improvement and follows up on outstanding customer inquiries and complaints within defined time frames.
  • Complies with HIPAA requirements and maintains confidentiality of Protected Health Information (PHI) for member, provider, medical and departmental information, and adheres to local, state, federal, and Healthfirst‑specific compliance and regulatory guidelines.
  • Builds sustainable relationships of trust through open and interactive communication with internal and external customers.
  • Works a flexible schedule including a late shift, weekends, and/or holidays (with limited notice at times), and as needed during unforeseen business disruptions.
  • Additional duties as required.

• High School Diploma or GED from an accredited institution.
• Prior experience in a customer service environment.
• Experience participating in cross‑functional projects and departmental initiatives related to customer/client interaction and customer service.
• Working experience in a fast‑paced environment.
• Proficient in Microsoft Office Suite applications including Excel, Word, and Outlook.

• Associate’s or Bachelor’s Degree from an accredited institution or equivalent work experience.
• Proven track record of exercising independent thinking, problem solving, and achieving goals.
• 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.
• Experience navigating multiple technologies including a Customer Relationship Management System (e.g., locating information, routing future actions, notating resolutions, updating member information).
• Basic knowledge of operational health plan departments and functionality.
• Working knowledge of Microsoft Office Power Point.
• Excellent verbal and written communication and the ability to document grammatically correct emails, communications, and presentations.
• Basic understanding of call center metrics including Average Handle Time (AHT), Quality, etc.

N/A

• Greater New York City Area (NY, NJ, CT residents): $40,200 - $54,570
• All Other Locations (within approved locations): $34,900 - $52,000

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 401(k) 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, a job promotion, or a transfer into this role.