Sr. Customer Service Representative (Hybrid-Remote)

Description & Requirements

Maximus is currently hiring a Sr.

Customer Service Representative! This position provides telephonic assistance to the Complaints Unit at the State Department of Health.

This position will require reviewing allegations of managed care organization (MCO) non-compliance with regulatory, statutory, and Department of Health program requirements.

This position investigates complaints from plan members, advocates, and providers involving the administration and payment of the Medicaid managed care benefit and obtains the information necessary for a thorough investigation.

This position is also assigned select processing duties, and additional administrative work.

The CSR works in the State Department of Health office.

This is a full time, hybrid remote position.

What you will receive:



* Starting pay: $18.75/hr


* Competitive healthcare benefits (medical, dental & vision)


* 401(k) retirement savings


* Paid time off (PTO)


* Holiday pay


* Great work/life balance

Essential Duties and Responsibilities:

- 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.

Minimum Requirements

Minimum Requirements:
- High school diploma or GED required and 1+ years of relevant professional experience required, or equivalent combination of education and experience.

-Handles more complex customer service inquiries and problems via telephone, recording consistent problem areas.
-May respond to email inquiries.
-Customer service is the primary function.
-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 gather...