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

• 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 gathering, and/or troubleshooting.
• May handle escalated or unresolved calls from less experienced representatives.
• Works on assignments that are moderately difficult, requiring judgement in resolving issues.
• Understands implications of work and makes recommendations for solutions

EEO Statement

Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We’re proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. Maximus is an Affirmative Action/Equal Opportunity Employer. Maximus provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.

Pay Transparency

Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances.

Hourly Base Pay Minimum for this Position

$ 18.75

Hourly Base Pay Maximum for this Position

$ 18.75

As a leading strategic partner to governments across the globe, Maximus helps improve the delivery of public services amid complex technology, health, economic, environmental, and social challenges. With a deep understanding of program service delivery, acute insights that achieve operational excellence, and an extensive awareness of the needs of the people being served, our employees advance the critical missions of our partners. Maximus delivers innovative business process management, impactful consulting services, and technology solutions that provide improved outcomes for the public and higher levels of productivity and efficiency of government-sponsored programs.