• Resolve customer inquiries via telephone and written correspondence • Answer inquiries from members and/or providers regarding claims, eligibility, covered benefits, authorizations and pharmacy related matters • Provide assistance to members and/or providers regarding website registration and navigation • Educate members and/or providers on health plan initiatives • Provide first call resolution; working with appropriate internal/external resources, completing necessary follow-up, and ensuring closure of the inquiry • Document all activities for quality and metrics reporting • Identify trends related to member and/or provider inquiries to respond proactively and provide feedback to management • Process and follow through on all matters related to Provider Addition, Change and Termination forms, Customer Service Forms, and claims projects in a timely manner. Conduct appropriate auditing processes • Process forms required to release pending claims to providers • Work with other departments on cross functional tasks and projects • Maintain performance and quality standards based on established call center metrics

• Review reports and patient charts to identify all new patients at various office locations • Contact first time patients to obtain basic demographic information prior to their first visit • Continual communication with other departments to obtain additional patient information • Send electronic correspondence to various Office Managers regarding any patients unable to be contacted. • Advise patients of the upcoming appointment with date/time as well as location-specific information • Strict adherence to HIPPA guidelines/regulations

• Processed Evidence Packets for consumer appeals • Developed templates with dropdown menus for appeal tasks • Trained new Representatives as a Certified Mentor • Determined the accuracy of in-process and processed health care applications • Take appropriate actions to make corrections for the New York Health Benefits Exchange • Processed appeals and complaints for enrollment and eligibility for health coverage • Appointed to Appeals Outreach Project to confirm/cancel current appeal for appellants of NYSOH • Appointed to Time Study Project • Point of Contact to assist Team Leads in assisting agents in finding resolution for consumer issues • Appointed to research potential conflicts in Work Instructions, filing reports with suggestions to management for resolution

• Answer incoming calls from consumers, prospective enrollees and assisting enrollees or acting on their behalf• Process new applications for health care, interpreting determinations made by the Marketplace and enrollment into health plans• Process life event changes, demographic updates, disenrollment requests, and special enrollment periods as requested• Appointed to new training module; both program & focus group

• Provide ongoing training and coaching to new hires • Inbound information collection for health insurance application • Input data to client portal for licensed agent use

• Input First Notice of Loss (FNOL) claims and assignments • Input initial automotive glass loss claims into database • Accurately record all pertinent first report information via telephone from the insured/claimant • Contact Glass Claims Services in escalated claims processes • Contact customer retailer of choice for glass repair/replacement

• Compared data entered with source documents, re-entered data in verification format • Deleted incorrectly entered data, re-entered correct data • Compiled, sorted, and verified accuracy of data to be entered • Reviewed and validated data reports for accuracy and completeness