Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Customer Satisfaction Lead Specialist (Syracuse)

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Manager & Professional
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190SS Requisition #
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The Customer Satisfaction Lead Specialist is responsible for coordination of all aspects of the Executive Complaint and Access to Care processes which are high visibility with quick turn-around time expectations, some in less than 24 hours.  Serves as the primary point of contact for the executive complaints and the access to care issues entering complaints in the Customer Relationship Management, (CRM), system, currently ESAWS, responding to questions, working directly with members, providers, groups, agents and brokers regarding status requests, etc. ensuring smooth handoffs and communication to maintain corporate and legislative compliance.  Monitors the dashboards ensuring all steps of each complaint is completed including verbal notification, effectuation and written notification.  Researches and responds to written/verbal executive complaints submitted by members and providers on behalf of members with individual customized responses based on the issues presented by the appellant.  Access to Care issues submitted by the Account Management and Sales team will be handled in the same manner.  Performs impact analysis on all identified issues, determines the root causes and tracks any require system updates or follow-up items.

Responsibilities:
  • Serves as liaison with EmblemHealth departments, members, providers and external contacts to obtain timely resolution of cases.
  • Conducts root cause analysis and propose resolution of individual and global issues.  Provide recommendations to management regarding cost saving opportunities, best practices and performance issues. 
  • Monitors the dashboard to ensure compliance with all due dates.  
  • Closes case files independently without prospective quality reviews, while mentoring and assisting other specialists.
  • Monitors daily volume in the Executive Complaints email box and the Access to Care email box to prioritize administrative functions including the front end retrieval and set-up of new work as well as the back end effectuation and notification of decisions.
  • Serves as the point of contact for the executive complaint team and to account management for Access to Care issues, providing guidance and status updates during daily huddles.
  • Works with departments of EmblemHealth and our delegated entities to ensure determinations are effectuated within stringent timeframes, following-up as necessary and validating upon completion.
  • Classifies and codes ESaws and/or any other customer service systems, inquiries; entering all actions taken in investigation for auditing and reporting purposes.
  • Prepares well written, customized responses to all member and provider correspondence that appropriately and completely address the complainant’s issues and are structurally accurate.  
  • Employee is responsible for tracking the individual due dates of each file ensuring timeframes are met. 
  • Regular attendance is an essential function of the job.  Performs other duties as assigned or required.
Qualifications:
  • Bachelor’s degree 
  • Additional relevant experience may be used in lieu of educational requirements
  • 3 -5 years of relevant experience required
  • Additional relevant experience may be used in lieu of educational requirements required
  • Product and regulatory knowledge required

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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