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.
REPORTS TO: Supervisor Operations
Additional Responsibilities:Candidate Education:
- 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
Licenses and Certifications:
- Advanced Demonstrated written communication skills
- Advanced Demonstrated interpersonal/verbal communication skills
- Intermediate Other Ability to follow direction
A license in one of the following is required: