
Authorized to work in the US for any employer
Results-driven professional with solid background in delivering impactful solutions. Proven track record in fostering team collaboration and adapting to changing needs. Skilled in strategic planning, project management, and client relations. Known for reliability, strong analytical abilities, and excellent communication skills.
-Receives and responds to routine member and/or provider inquiries, requests and/or concerns in an accurate and timely manner
-Mitigates and prevents complaints from being escalated to resolve in initial contact.
-Serves as the front-line resolution advocate on various member and/or provider inquiries, requests, or concerns
-Resolves basic problems by communicating the requested information regarding the assessment of the member or provider needs, understanding the cause, and determining if problems need to be routed to other departments for further resolution
-Maintains performance and quality standards based on established contact center metrics
-Provides customer service in a high pace contact center environment over the phone, via live chats and emails
-Documents all member or provider information and communications for quality and performance tracking through the Customer Relationship Management (CRM) applications
-Remains up-to-date and adheres to quality standards, regulation, and all other policies to ensure quality, consistency, and compliance
-Performs other duties as assigned
-Complies with all policies and standards
-Assist team agents on teams chat with any questions when needed
-Assist provided my team with Central Point Updates Articles every day
-Increased customer satisfaction significantly within calls
-Helped large volume of members every day with positive attitude and focus on customer satisfaction
-Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns
Provides timely and appropriate resolutions to escalated issues received from various communication channels.
Serves as a liaison in maintaining relationships between departments to ensure timely and appropriate issue resolution.
Supports the documentation, tracking, and resolution to all assigned complaints and inquiries in writing and/or by telephone in a timely and professional manner.
Supports root cause analysis of member/provider issues to identify trends across the enterprise, and works cross functionally with all departments to ensure enterprise-wide solutions.
Helps to coordinate with contact center team to research underlying facts of escalated inquiries, determine validity of complaints and evaluate options to remedy these complaints.
Reviews complaint trends and uses guidance of senior team members to develop draft recommendations that are designed to enhance member and provider experience and reduce complaints and escalations.
Maintains basic, introductory knowledge of our products and services to provide accurate and effective support to customers.
In some instances, researches and identifies basic claims payment errors and make appropriate adjustments.
Performs other duties as assigned.
Complies with all policies and standards.
Marketing Misrepresentation calls, supporting Medicare, may include, but no limited to, access to care issues, escalated members, mitigating potential CTM's.
Ensured high-quality handling of claims by reviewing cases for accuracy, compliance, and timely resolution while maintaining strong attention to details.
During downtime or in between calls may be assigned to work in Omni Material Requests.