Customer Service Representative II - Mexico, NY

Essential Duties and Responsibilities:
- Serve as a subject matter resource for customer inquiries received via telephone, interactive voice response (IVR), web based portals, or outreach activities regarding program information and services.
- Manage and support escalated enrollment cases and processes in accordance with established case resolution procedures.
- Respond to complex or sensitive customer concerns by applying program policies, procedures, and guidelines to determine appropriate actions or referrals.
- Accurately document customer interactions, case activity, outreach efforts, and actions taken in applicable systems.
- Navigate and utilize multiple systems, tools, and data sources to retrieve, review, compare, analyze, and verify customer or program information.
- Conduct outbound contacts to customers to obtain corrections, clarification, or required documentation to support case resolution or enrollment verification.
- Review and compare customer submitted documentation, including income or eligibility materials, against application data to verify accuracy and compliance.
- Apply program knowledge to educate customers on program offerings, eligibility requirements, enrollment options, and available services.
- Support customers throughout multiple phases of the application or service lifecycle, from enrollment through receipt of benefits or services.
- Identify issues, trends, or barriers impacting customer engagement or service delivery and report concerns to management or project staff as appropriate.
- Collaborate with internal teams, client escalation groups, and external partners to support effective resolution of customer issues and project objectives.
- Maintain confidentiality and security of customer, provider, and program information at all times.
- Meet or exceed established productivity, quality assurance, and performance standards.
- Attend required meetings and trainings and maintain up to date knowledge of programs, systems, policies, procedures, and compliance requirements.
- Perform other related duties as assigned by management.

- Conduct face-to-face and/or virtual (telephonic) outreach and enrollment services, including education on managed care options and public health programs to clients at LDSS/HRA offices

- Assist clients with the enrollment/transfer/disenrollment process

- Interface and maintain professional and positive relationships with HRA/LDSS county staff and clients

- Assist Call Center Operations and other departments as determined by project management to meet business needs

- Regular member of a processing unit within the Outreach department:

EEU

Data Entry

Manual Notices

- Conduct shadowing / training activities with new hires

- Works in assigned special projects

- Maintain Certified Application Counselor CAC active certification

- Conduct Certified Application Counselor (CAC) tasks in select counties

- Maintain updated knowledge of the New York Medicaid Choice Project

- Meet a...