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: DIRECTOR, STATE REGULATORY AFFAIRS
DEPARTMENT: HI-OPERATIONS-CUSTOMER SERVICE STATE
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.
- Track grievance case by line of business for compliance and review.
- Assist in resolving member and provider complaints
- 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 quality audit score and productivity.