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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.
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.
Required A High School or GED
Preferred An Associate's Degree in a related field
Required 1 year of experience in a call center or customer service environment
Required 6 months of experience in Experience in a healthcare environment
Advanced Demonstrated written communication skills
Advanced Demonstrated interpersonal/verbal communication skills
Intermediate Other Ability to follow direction
Licenses and Certifications: A license in one of the following is required: