Customer Care Resolution Specialist

Job Summary:

The Customer Care Resolution Specialist is responsible for being a subject matter expert and effectively handling and resolving escalated calls from members and providers.

Essential Functions:

• Acts as subject matter expert, while staffing the assist line and accurately responding to inquiries presented by Customer Care Specialists
• Effectively handle and resolve escalated calls from members and providers
• Act as a New Hire Transition Coach for new employees

Identify gaps in current processes and partner with Business Integration Team to solve those issues.

• Provide Peer to Peer feedback
• Identify training needs for Customer Care Specialists
• Manage and process incoming work from internal route boxes, incoming faxes, email, web inquires, and ServiceNow queues
• Partner with other departments to ensure internal service levels are achieved
• Utilize self-education opportunities to stay abreast of procedural updates – maintain Subject Matter Expert (SME) status in all skill sets
• Document all second level support questions by utilizing and maintaining the Assist Line Tracking Database
• Act as a role model to other employees by displaying a positive attitude, being helpful and approachable, motivating others and being accountable for actions
• Assist members and providers with routine service inquires
• Ensure all HIPAA and State requirements/regulations are adhered to at all times in existing and future lines of business
• Research, follow up and resolve all open/pending issues in a timely manner to ensure member satisfaction
• Maintain knowledge and understanding of, and adhere to, all processes and procedures

May be required to create and conduct departmental training, as business needs dictate; successful completion of the CareSource University Functional Facilitator certification program is required prior to fulfilling these duties

Perform any other job duties as requested

Education and Experience:

• High School education or equivalent required
• Minimum of one (1) year experience in Customer Care  (Member Services or Provider Services) required
• Minimum of three (3) years customer service experience in a call center is preferred
• Minimum of two (2) years of HMO or related industry experience is preferred

Competencies, Knowledge and Skills:

• Strong understanding of Customer Care processes
• Ability to deescalate difficult conversations
• Ability to determine root cause of problems and propose solutions
• Computer proficiency with knowledge and experience in a “Windows” environment

Typing, 35 WPM

• Claims and Coding Experience (ICD9, CPT4, HCPCS, Revenue Code and Dental Coding)
• Excellent written and communication skills
• Professional phone etiquette
• Proper use of grammar
• Ability to work in a fast paced environment
• Adaptable to a constantly changing environment
• Attention to detail
• Ability to multitask
• Ability to work independently and with a team
• Critical thinking and listening skills
• Decision making and problem solving skills
• Ability to coach and provide feedback effectively
• Understanding of Medicaid

Working Conditions:

General office environment; may be required to sit or stand for extended periods of time

Must adhere to an assigned daily work schedule and have predictable and reliable attendance