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Corporate Functions & Operations WellCare - Membership Support Careers

Member Resolution Specialist Job

Full Job Title: Member Resolution Specialist

Job Number: 1700192

Location: Nashville, TN

Date Posted: 10-12-2017

"PLEASE NOTE: THIS IS A CALL CENTER ENVIRONMENT"


Responds to all escalated member complaints received through transferred phone calls and customer service management and resolves those issues. Responsibilities also include miscellaneous special project work.


DEPARTMENT: OPERATIONS NASHVILLE CALL CENTER

POSITION LOCATION: NASHVILLE, TN 37211

Essential Functions:

  • Logs, tracks, resolves and responds to all assigned inquiries and complaints while meeting all regulatory, CMS, and WellCare Corporate guidelines in which special care is required to enhance WellCare relationships; while meeting and exceeding all performance standards.
  • Thoroughly researches issues and takes appropriate action to resolve them within turnaround time requirements and quality standards.
  • Identify root cause issues to ensure enterprise solutions and communicate findings as needed.
  • Acts as a liaison between internal departments on data gathering and problem solving while investigating problems of an unusual nature in the area of responsibility.
  • Presents proposed solutions in a clear and concise manner.
  • Assists with special projects as assigned or directed.
Candidate Education:
  • High School or GED is required
  • Associate's Degree in a related field is preferred
Candidate Experience:
  • 1 year of experience in a call center or customer service environment is required
  • 6 months of experience in a healthcare environment is preferred
Candidate Skills:
  • Demonstrated written communication skills
  • Demonstrated interpersonal/verbal communication skills *LI-RG1

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Last Updated On: 12/9/2015