Member Service Representative

Grounded by a compelling mission, core values, and compassion for people, CDPHP and its family of companies offer a strong foundation for a rewarding career. Established in 1984, CDPHP is a physician-founded, member-focused, and community-based not-for-profit health plan that offers high-quality affordable health insurance to members throughout New York. The company values people, quality, innovation, and community, and its corporate culture supports those values wholeheartedly. CDPHP is committed to fostering a culture of belonging and takes a wholistic approach to diversity, equity, and inclusion. At CDPHP, the employees have a voice and are encouraged to make an impact at both the company and community levels through engagement and volunteer opportunities. CDPHP invests in employees who share these values and invites you to be a part of that experience.

The Member Service Representative shall assume full responsibility and ownership for all aspects regarding education of the member, the Employer Groups, Brokers and/or prospective members regarding the proper utilization of the Plan. In addition, the incumbent will address and resolve service problems, complaints, and advise the customer of their rights and responsibilities. The Member Service Representative will work closely with all departments, such as Marketing, Enrollment, Pharmacy (internal and external), Provider Services, and Claims Operations to resolve member inquiries as defined within Member Services Procedures. The incumbent will also review eligibility requirements, provide rates for various health products, provide usual and customary rates based on procedural codes, and assist prospective members with enrollment applications as requested by the customer. Representatives are required to handle multiple product lines, complete system updates and respond to members via telephone and correspondence.

QUALIFICATIONS:

• High school diploma or GED required.
• One year of customer service experience required.
• Two or more years of customer service preferred.
• Experience with a documentation system to track inquiries generated and received preferred.
• Strong working knowledge of Microsoft Word required.
• Demonstrated ability to determine, analyze and solve problems related to benefits, claims processing, claims and benefit appeals/complaints, enrollment and premium billing issues required. Demonstrated ability to successfully apply problem solving and time management methodology, balance multiple tasks as business needs arise while maintaining production and quality standards and meet deadlines.
• Ability to interpret all CDPHP's health plan contract language, riders, schedules.
• Demonstrated ability to effectively communicate on a verbal and written basis using appropriate grammar, spelling, punctuation, and sentence structure is required with members, providers, marketing, pharmacists, governmental agencies, and other persons associated with CDPHP on the phone, written correspondence and/or face-to-face while maintaining a professional approach is required.
• Strong attention to detail and capability to meet established quality and productivity standards.
• Ability to complete system updates.

Hourly rate: $20.00/hour. Please note, there are two shifts available for this position. Candidates are considered for 9:30am - 6pm, or 11:30am-8pm shifts. This is a remote position - great opportunity to work from home!

CDPHP salary ranges are designed to be competitive with room for professional and financial growth. Individual compensation is based on several factors unique to each candidate, such as work experience, qualifications, and skills. In addition to cash compensation, CDPHP employees may be eligible for an incentive payment, a discretionary cash reward based on employee and company performance. Some roles may also be eligible for overtime pay.

CDPHP compensation packages go far beyond just salary. The company offers a comprehensive total rewards package that includes award-winning health care coverage, health care dollars, a generous paid time off allowance, employee assistance programs, flexible work environment, and much more. Learn about all CDPHP employee benefits at https://www.cdphp.com/about-us/jobs/benefits.

As an Equal Opportunity / Affirmative Action Employer, CDPHP will not discriminate in its employment practices on the basis of race, color, creed, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, protected veterans status, or any other characteristics protected under applicable law. To that end, all qualified applicants will receive consideration for employment without regard to any such protected status.

CDPHP and its family of companies include subsidiaries Strategic Solutions Management Consultants (SSMC), Practice Support Services (PSS), and ConnectRx Services, LLC.