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Corporate Functions & Operations
WellCare - Customer Service Careers

Lead Customer Service Representative - Bilingual (Mandarin/Cantonese) Required Job

Full Job Title: Lead Customer Service Representative - Bilingual (Mandarin/Cantonese) Required

Job Number: 1802001

Location: New York, NY

Date Posted: 3-19-2018

Responds to member, provider and regulatory agencies' inquiries and escalations (phone, written, or walk in) regarding all aspects of WellCare business, including but not limited to enrollment, billing, claims and pharmacy in a professional, timely, accurate and caring manner while consistently meeting all regulatory guidelines. Serves in a limited leadership capacity as a subject-matter-expert, mentor and coach.
Essential Functions:
  • 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.
  • Acts as a mentor for all CSR's. Provides real-time feedback as appropriate for the job function.
  • Acts as a Subject Matter Expert (SME).
  • Works with department management to maintain daily workflow within the department in order to maximize productivity. Assists in the development of long-range goals and drives through to completion.
  • 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.
  • Logs, tracks, follows-up and appropriately documents all issues utilizing on-line systems and procedures, and in accordance with all applicable guidelines and requirements.
  • Acts as a liaison between internal departments on data gathering and problem solving.
  • Works with external organizations (i.e., Social Security Administration (SSA) and CMS) to help resolve member and provider problems.
  • Drives and supports WellCare initiatives at the team 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.
  • Assists in the education of new members and in the re-education of existing members regarding health plan procedures.
  • 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.
  • Conducts one-on-one training and coaching.
  • Occasionally performs specific supervisory functions.
  • Assists with Quality Initiatives such as call monitoring, C-SAT follow-up and all reinforcement of quality service at the team and department levels.
  • Provides feedback when acting in a mentor-role with CSR's.
  • Makes decisions that are consistent with the concept of a win-win-win for members, associates and WellCare.
  • Assists with other projects and duties as assigned.
Education: High School Diploma
3-5 years experience within a healthcare customer service or call center environment
Licenses/Certifications: Customer service, quality or training certifications (preferred)
Special Skills (e.g. 2nd language):
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 customers
Ability to communicate effectively with individuals identified in Work Relationships
Ability to define problems, collect data, establish facts and draw valid conclusions
Ability to apply sound judgment and decision-making skills in dealing with a variety of routine and non-routine issues
Ability to explain higher-level work functions to co-workers and base-level CSR's when acting in a mentor/leadership role
Seeks to build trust, respect and credibility with all partners through full, honest, consistent, and coordinated communication
Technical Skills/Requirements:
Proficiency with Microsoft Outlook sufficient to easily and readily communicate with both internal and external contacts
Proficiency with Word and/or Excel sufficient to easily and readily manipulate data
Proficiency with all WellCare Based Systems utilized in job-function

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Last Updated On: 12/9/2015