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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. Serves in a limited leadership capacity as a subject-matter-expert, mentor and coach.
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
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.
Identify root cause issues to ensure enterprise solutions and communicate findings as needed.
Assists Team members often guiding them to the appropriate resolution of more complex and difficult cases.
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 in the education of new members and in the re-education of existing members regarding health plan procedures.
Occasionally performs specific supervisory functions.
Assists with Quality Initiatives such as call monitoring and all reinforcement of quality service at the team and department levels.
Assists with special projects as assigned or directed
Required A High School or GED
Preferred An Associate's Degree in a related field
Preferred or equivalent work experience
Required 3 years 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: