This position is forEasy Choice Health Plan Inc.in Cypress, CA, a WellCare Healthplans, Inc. company.
Responds to member and provider inquiries (phone, written or walk in) regarding all aspects of WellCare business, including claims and pharmacy, in a professional, timely, accurate and caring manner while consistently meeting all guidelines. Serves in a limited leadership capacity as a subject-matter-expert and mentor.
Department: CA – Operations State
Reports to: Sr Mgr, State Operations
Location: 10803 Hope Street, Suite B, Cypress, CA 90630
Job Type: Hourly/Non-exempt
- Responds to basic member, provider and other inquiries via telephone, correspondence or lobby walk-in while meeting all corporate guidelines and performance standards.
- Acts as a primary contact for escalated calls and/or escalated issues in which special care is required to enhance WellCare relationships with members and providers.
- Handles calls that require additional research and/or special handling including regulatory, congressional, trust, marketing, sales, executive office, Centers for Medicare and Medicare Services (CMS), etc.
- Investigates problems of an unusual nature in the area of responsibility. Presents proposed solutions in a clear and concise manner.
- Acts as a liaison between internal departments on data gathering and problem solving.
- Drives and supports WellCare initiatives at the team level by interacting with peers and other internal and external business partners while demonstrating a willingness to conform to WellCare policies and procedures.
- Demonstrates appropriate customer-care skills such as empathy, active listening, courtesy, politeness, helpfulness, and other skills as identified.
- Records, investigates and resolves customer complaints as detailed in the Grievance Procedure narrative.
- Assist in the education of new members and in the re-education of existing members regarding health plan procedures.
- Logs, tracks and follow-ups on all inquiries, utilizing on-line systems and procedures, according to the established guidelines.
- Demonstrates expertise within all assigned LOB's. Handles calls for multiple LOB's as assigned.
- Performs skills necessary to create a high-quality customer experience, as reflected through acceptable C-Sat scores, quality monitors and member feedback.
- Acts as a Subject Matter Expert (SME).
- Assists with other projects and duties as assigned.
Education: High School Diploma
- 1-2 years experience within a call center or customer service environment
- Experience within a health care company preferred
Licenses/Certifications: Customer service, quality, or training certifications (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
- Proficiency with Microsoft Outlook to easily and readily communicate with both internal and external contacts
- Proficiency with Word and/or Excel sufficient to easily and readily manipulate data