Account Services Representative

Ensures prompt, accurate, and efficient servicing of all Broker, Member, and Employer Group Administrator inquiries via telephone, email, written inquiries, lobby walk-ins, or on-site visits. Provides professional, timely resolution to enhance Group & Broker satisfaction and retention while maintaining constant communication with Sales staff and other business partners.

Responsibilities

• Implement new groups, renewals, and conversions to new product lines.
• Research, interpret, and respond to inquiries from internal and external customers, brokers, consultants, and groups regarding products, services, and policies in accordance with MTM, Corporate Service strategy, NCQA, and legislative requirements.
• Ensure all inquiries are responded to within 24-48 hours, with same-day response preferred where possible.
• Interact with Operations, Enrollment and Billing, Customer Care, Claims, Advocacy, Clinical Operations, Medical Affairs, and Finance/Underwriting to resolve issues.
• Maintain accurate and timely account data, including initial setup, benefit books, summaries, and contracts.
• Partner with the Project Management team to support vendor relationships and electronic enrollment methods for assigned book of business.
• Utilize standard and custom products in manual workflows to meet external client needs.
• Validate group setup and renewal completions.
• Complete required training to support job functions.
• Demonstrate high standards of integrity, supporting the company’s mission and values, and adhering to the Corporate Code of Conduct.
• Maintain member privacy in accordance with corporate policies.
• Adapt to changes and business needs while taking ownership of issue identification and resolution.
• Handle 50-100 calls per day and manage three broker support lines.
• Assist with broker support tasks, including answering calls, running reports, addressing benefit inquiries, and responding to emails.

Level II Responsibilities

• Assist with on-the-job training for Account Service and Sales Account Managers.
• Support Level I team members with complex issues.
• Participate in ongoing meetings, training, and skill development to support career growth.
• Identify patterns, trends, and issues affecting customer satisfaction; recommend process improvements.
• Represent the Account Service Team in meetings and share learned information with staff.
• Handle HIPAA-related issues, including Designated Record Set (DRS) requests, and serve as a point person for complex information requests.

Level III Responsibilities

• Assist management with tasks requiring advanced problem-solving skills.
• Partner with Sales to create and deliver client presentations.
• Mentor and train junior team members to resolve outstanding or difficult issues.
• Act as a backup to the Account Manager during absences.
• Travel within the Health Plan service region to support on-site visits, open enrollments, training, or off-site meetings.

Requirements

• High School diploma or equivalent required; Associate’s Degree in a related field preferred.
• In lieu of a degree, 2 years of experience in service or healthcare industries is acceptable.
• Valid NYS Life, Accident, and Health license required within six months of employment.
• Familiarity with NYS and Federal regulations and underwriting policies is a plus.
• Strong oral/written communication, customer service, and organizational skills.
• Ability to prioritize, multitask, and work in a fast-paced environment under pressure.
• Complete required internal Medicare Training per Center for Medicare Services within one year of start date.
• Proficiency in PC skills, including spreadsheet and word processing applications, database functions, and sales force automation software.

Level II Requirements

• Two or more years of experience in a sales operations environment.
• Valid NYS Life, Accident, and Health license.
• Knowledge of NYS and Federal regulations, underwriting policies, and process flows.
• Demonstrated relationship-building skills.

Level III Requirements

• Five or more years of experience in a sales operations environment.
• Valid NYS Life, Accident, and Health license.
• Proficiency with NYS and Federal regulations, underwriting policies, and process flows.
• Experience creating and delivering client presentations.
• Excellent analytical and problem-solving skills.

Skills

• Health insurance
• Account management
• Customer service
• Benefits administration and management
• Medicare knowledge
• Computer proficiency, including navigating multiple systems

Pay

$22.00 - $24.00 per hour.

Benefits

Eligibility requirements apply to some benefits and may depend on job classification and length of employment. Benefits are subject to change and may include:

• Medical, dental, and vision insurance
• Critical Illness, Accident, and Hospital coverage
• 401(k) Retirement Plan (Pre-tax and Roth post-tax contributions available)
• Life Insurance (Voluntary Life & AD&D for employee and dependents)
• Short- and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation, or Sick Leave)

Schedule

This is a fully remote, contract position based in Rochester, NY.