Sr. Customer Service Representative - Albany, NY

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 (DOH).

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 an ONSITE position located in Albany, NY.

What you will receive:

Work/Life Balance Support - Flexibility tailored to your needs!

• Competitive Compensation - Bonuses based on performance included!

•Comprehensive Insurance Coverage - Choose from various plans, including Medical, Dental, Vision, Prescription, and partially funded HSA.

Additionally, enjoy Life insurance benefits and discounts on Auto, Home, Renter's, and Pet insurance.

• Future Planning - Prepare for retirement with our 401K Retirement Savings plan and Company Matching.

• Paid Time Off Package - Enjoy PTO, Holidays, and extended sick leave, along with Short and Long Term Disability coverage.

• Holistic Wellness Support - Access resources for physical, emotional, and financial wellness through our Employee Assistance Program (EAP).

• Recognition Platform - Acknowledge and appreciate outstanding employee contributions.

• Diversity, Equity, and Inclusion Initiatives - Join a workplace committed to fostering diversity and inclusion.

• Tuition Reimbursement - Invest in your ongoing education and development.

• Employee Perks and Discounts - Additional benefits and discounts exclusively for employees.

• Maximus Wellness Program and Resources - Access a range of wellness programs and resources tailored to your needs.

•Professional Development Opportunities: Participate in training programs, workshops, and conferences.

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 emai...