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Corporate Functions & Operations WellCare - Membership Support Careers

Member Resolution Specialist - Lead Job

Full Job Title: Member Resolution Specialist, Lead

Job Number: 1805660

Location: Statewide, FL

Date Posted: 2018-08-16

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.

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
  • 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
Additional Responsibilities:
    Candidate Education:
    • Required A High School or GED
    • Preferred An Associate's Degree in a related field
    • Preferred or equivalent work experience
    Candidate 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
    Candidate Skills:
    • 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:
      Technical Skills:

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          Last Updated On: 12/9/2015