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
POSITION LOCATION: KAPOLEI, HI 96707
- 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.
- 6 months to 1 year practical work experience
- Previous experience in a call center or customer service environment is preferred
- Customer service, quality or training certifications is preferred
Special Skills (e.g. 2nd language):
- Strong written and verbal communication skills and an 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
- Knowledge of email systems such as Microsoft Outlook sufficient to communicate with both internal and external contacts
- Knowledge of Word and/or Excel sufficient to enter data