Responds to member, provider and regulatory agencies’ inquiries and escalations (phone, written, or walk in) regarding all aspects of WellCare business within Operations in a professional, timely, accurate manner while consistently meeting all regulatory guidelines. Coaching and training new team members in addition to veteran associates. Serves in a limited leadership capacity as a subject-matter-expert, mentor and coach.
Reports To: Supervisor, Operations
Position Location: Houston, TX 77081
Additional Responsibilities: Candidate Education:
- Responds to basic member, provider and other inquiries via telephone, correspondence or lobby walk-in while meeting all corporate guidelines and performance standards.
- Acts as a primary contact for escalated calls and/or escalated issues in which special care is required to enhance WellCare relationships with members and providers.
- Acts as a mentor to associates. 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.
- Handles issues that require additional research and/or special handling including regulatory, congressional, trust, marketing, sales, executive office, Centers for Medicare and Medicare Services (CMS), etc.
- Investigates problems of an unusual nature in the area of responsibility in order to identify root cause. Presents proposed solutions in a clear and concise manner.
- Logs, tracks, follows-up and appropriately documents all issues utilizing on-line systems and procedures, and in accordance with all applicable guidelines and requirements.
- Acts as a liaison between internal departments on data gathering and problem solving.
- Works with external organizations (i.e., Social Security Administration (SSA) and CMS) to help resolve member and provider problems.
- Drives and supports WellCare initiatives at the team by interacting with peers and other internal and external business partners while demonstrating a willingness to conform to WellCare policies and procedures.
- Assists in the education of new members or providers and in the re-education of existing members or providers regarding health plan procedures.
- Demonstrates expertise within all assigned LOB’s.
- Performs skills necessary to create a high-quality customer experience, as reflected through acceptable C-Sat scores, quality monitors and member feedback.
- Logs, tracks, resolve and responds to state regulators and market inquiries.
- Assists with other projects and duties as assigned.
- Performs production related work as necessary.
- 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 related field based on Operational area
- Preferred Other Previous experience in a healthcare environment
Licenses and Certifications:
- Intermediate Ability to effectively present information and respond to questions from families, members, and providers
- Intermediate Demonstrated interpersonal/verbal communication skills
- Intermediate Ability to create, review and interpret treatment plans
- Intermediate Other Ability to read, analyze and interpret verbal and written instructions
- Intermediate Other Ability to write business correspondence
- Intermediate Other Ability to apply sound judgment and decision-making skills in dealing with a variety of routine and non-routine issues
- Intermediate Other Seeks to build trust, respect and credibility with all partners through full, honest, consistent, and coordinated communication
A license in one of the following is required:
- Preferred Other Customer service, quality or training certifications
- Required Intermediate Microsoft Outlook
- Required Intermediate Microsoft Excel
- Required Intermediate Microsoft Word
- Required Intermediate Other Proficiency with all WellCare Based Systems utilized in job-function
- Preferred Other Other Languages