Location: Idlewild Ave, Tampa, FL
Reporting to: Supv, Operations
Department: Ops-Compliant Resolution
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.
- 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.
Education: High School Diploma required, associates degree preferred
Experience: 1-3 years experience within a call center or customer service environment
1 year Grievance experience preferred
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, analyzes, and interprets verbal and written instructions
Ability to write business correspondence
Ability to effectively present information and respond to questions from members
Ability to define problems collects 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