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.


To protect the health and safety of our workforce, members, patients, and the communities we serve, the EmblemHealth family of companies require all new employees to be fully vaccinated for COVID-19. Exemption/reasonable accommodations may be granted because of 1) a qualifying medical condition or disability that makes getting the vaccine unsafe for the individual, or 2) objection on the basis of sincerely held religious beliefs and/or practices.

Medicare Customer Service Associates (Multiple Positions)

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Operations
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ConnectiCare
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We are seeking dynamic Medicare Customer Service Associates to join our Call Center in Farmington, CT starting February 2022! The Medicare Customer Service Associate will provide telephonic customer service support to ConnectiCare members, providers and facilities. Inquiries can range from verifying information, question regarding bill, locating a Physician in accordance to their plan, etc. They will be responsible for addressing any issues under ConnectiCare’s various plans as it relates to areas of coverage, payment of claims, membership status, medical management intake calls, etc.

Description of Duties:

  • Receives and responds to telephone calls and correspondence from members, regarding billing, benefits, coverage, payment, coding, and health services policies and procedures.
  • Maintains telephone log documenting number, content and type of calls received.
  • Explains medical pre-authorization requirements and disposition of pre-authorization requests, as necessary.
  • Researches and analyzes recurring billing and eligibility problems/complaints to determine root causes and trends. 
  • Collaborates with Management to identify areas of member/participant dissatisfaction and trends concerning membership or benefits.
  • Researches and analyzes recurring member problems/complaints to determine root causes and trends; recommends solutions and/or resolutions.
  • Provides instruction to members for submitting out-of-plan medical claims.
  • Acts as customer advocate in providing assistance to resolve callers' issues and problems. 
  • May provide instruction to members for obtaining prior approval on benefits that have certain restrictions.
  • Investigates requests for claims adjustments by callers and collaborates with Claims teams to ensure claims adjustments have been made. Follows thru w/callers by communicating when/if adjustments cannot be made.
  • Performs other related projects and duties as assigned. 

Qualifications: 

  • Post High School education/training or equivalent combination of education and experience.
  • At least 2 years of previous customer service experience in a medical office, sales/service or billing environment required; telephonic customer service experience preferred.
  • Knowledge of Medicare Regulations/Product, ICD-9 and ICD-10 diagnosis, CPT-4, UB82 revenue codes, UB92 revenue coding and procedural coding desired.
  • Excellent oral and written communication skills and interpersonal skills required.
  • Previous system user experience in a highly automated environment required. Strong personal computer skills.
  • Demonstrated analytical skills desirable.
  • Excellent telephone manner: ability to handle high volume of calls efficiently and courteously.
  • Ability to perform in office environment with extended periods of sitting, using telephone, viewing computer screens, standing, reaching, lifting files, binders, computer reports.
  • Bi-lingual Spanish speaking preferred

Essential Job Requirements:

  • Primarily sedentary
  • Must be able to use standard office equipment

Test Subjects:

  • Online: Reading Comprehension
  • Online: Customer Service
  • Oral Telephone Simulation; Interview

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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