Customer Service Representative

Responds to member and provider inquiries (phone, written or walk in) regarding all aspects of WellCare business, including claims, in a professional, timely, accurate and caring manner while consistently meeting all guidelines.

REPORTS TO: SUPERVISOR, CUSTOMER SERVICE
DEPARTMENT: HAWAII, CUSTOMER SERVICE OPERATIONS
POSITION LOCATION: KAPOLEI, HI 96707
Essential Functions:
  • Responds to member, provider and other inquiries via telephone, correspondence or lobby walk-in while meeting all corporate guidelines and performance standards.
  • Demonstrates appropriate customer-care skills such as empathy, active listening, courtesy, politeness, helpfulness and other skills as identified.
  • Records, investigates and resolves member complaints as detailed in the Grievance Procedure narrative.
  • Assists in the education of new members and in the re-education of existing members regarding health plan procedures.
  • Logs, tracks and appropriately documents all issues utilizing on-line systems and procedures, and in accordance with all applicable guidelines and requirements.
  • Makes decisions that are consistent with the concept of a win-win-win for members, associates and WellCare.
  • Demonstrates based behaviors such as initiative, accountability and value.
  • Performs skills necessary to create a high-quality customer experience, as reflected through acceptable C-Sat scores, quality monitors and member feedback.

Education:

  • High School Diploma is required
Experience:
  • 6 months to 1 year practical work experience
  • Previous experience in a call center or customer service environment is preferred
Licenses/Certifications:
  • Customer service, quality or training certifications is preferred
Special Skills (e.g. 2nd language):
  • Written and verbal communication skills
  • Ability to work with people from diverse backgrounds
  • Ability to multi-task, good organizational and time management skills
  • Ability to act on feedback provided by showing ownership of his or her own development
  • Ability to read, analyze, and interpret verbal and written instructions
  • Ability to write business correspondence
  • Ability to effectively present information and respond to questions from members
  • Ability to define problems, collect data, establish facts and draw valid conclusions
  • Seeks to build trust, respect and credibility with all partners through full, honest, consistent, and coordinated communication
Technical Skills/Requirements:
  • Knowledge of email systems such as Microsoft Outlook sufficient to communicate with both internal and external contacts
  • Knowledge of MS Word and/or MS Excel sufficient to enter data

About us
Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses exclusively on providing government-sponsored managed care services through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans to families, children, seniors and individuals with complex medical needs. WellCare is a Fortune 500 company, and in 2018, was recognized as a Fortune "World's Most Admired Company", ranking in the top five among the health insurance and managed care industry-a testament to the hard work and dedication of the company's nearly 9,000 associates who each day live WellCare's values and deliver on its mission to help its members live better, healthier lives. The company serves approximately 4.4 million members nationwide as of Dec. 31, 2017. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.