Carrie Garling

Provide expertise and customer service support to members, customers and/or providers

· Serve as the liaison to a complex customer base to manage first level response and resolution of escalated issues with external and internal customers

· Identify and resolve operational problems using defined processes, expertise and judgment

· Investigate claim and/or customer service issues as identified and communicate resolution to customers

· Provide feedback to team members regarding improvement opportunities

· Managed customer conflicts and challenging situations by staying calm and accessing internal knowledge bases to develop strategic solutions.

· Evaluated UES Close Loop/ NPS Detractor Work. Reviewed low UES survey scores, if score can be rebutted.

· Coached and motivated Care Advisors to boost performance and enhance job knowledge.

Followed up with Families back on escalated situations from the Team Lead Call back Share-point.

· Provided holistic family support to members that may have special needs or a child/family member with special needs.

· Main contact for assigned families, via phone or email.

Formulate, prioritize, organize, and follow up with members on escalated issues.

· Examined claims forms and other records to determine insurance coverage.

· Paid and processed claims within designated authority level.

Reported overpayments, under payments, and other irregularities.

· Delivered fast, friendly and knowledgeable service for routine questions and service complaints.

· Referred unresolved customer grievances to designated departments for further investigation.

· Motivated and goal oriented, with the passion to go above and beyond for a member while meeting business metrics.

· Utilized active listening skills and asked open-ended questions to ascertain customer call needs.