Description & Requirements
Maximus is currently looking for a Sr. Customer Service Representative to join our growing team. This position is responsible for providing response to inbound inquiries from New York State providers regarding unpaid claims and other billing-related concerns.

• Interface with clients and refer complaints or inquiries to appropriate departments, agencies, advocates, or client representatives.
• Stay updated on managed care relevant to supported client programs.
• Adhere to processing guidelines, protocols, and contract requirements for complaint processing and handling PHI/PII.
• Assist consumers in health plan enrollment, disenrollment, and transfers when necessary.
• Fulfill assigned duties directed by the Complaint Unit Supervisor or Project Management.
• Meet performance standards outlined in the annual criteria and bonus template for the position.
• Address complex customer service inquiries and problems over the telephone, noting consistent issues for resolution.
• Potentially respond to email inquiries.
• Prioritize customer service as the primary function, handling non-routine calls requiring deviation from standard procedures.
• Manage situations needing adapted responses or extensive research based on customer needs.
• Utilize computerized systems for tracking, information gathering, and troubleshooting.
• Handle escalated or unresolved calls from less experienced representatives.
• Tackle moderately difficult assignments, exercising judgment in issue resolution and recommending solutions.
• Maintain updated knowledge of managed care as it relates to client supported programs.
• Meet the established processing guidelines, protocols and contract requirements related to complaint processing and the handling of PHI/PII.
• Perform other duties as may be assigned by the Complaint Unit Supervisor and/or Project Management.
• Meet all standards established for this position as outlined in the corresponding annual performance criteria and bonus template for this position.
• Handles more complex provider inquiries and problems via telephone, recording consistent problem areas.
• May respond to email inquiries.
• Calls are non-routine and require deviation from standard screens, scripts, and procedures.
• Handles situations which may require adaptation of response or extensive research according to customer response.
• Uses computerized system for tracking, information gathering, and/or troubleshooting.
• May handle escalated or unresolved calls from less experienced representatives.
• Works on assignments that are moderately difficult, requiring judgement in resolving issues.
• Understands implications of work and makes recommendations for solutions.
• Demonstrates strong attention to detail to ensure accuracy and thoroughness in all tasks and documentation.
• Follows established guidelines and directions while maintaining a proactive approach to meeting objectives and deadlines.
• Effectively manages multiple tasks and priorities under pressure, ensuring high-quality outcomes in a fast-paced environment.
• Performs other duties as assigned by managemen