Kamischa Blitch

Resolve complex inquiries and report to the Centers for Medicare and Medicaid Services (CMS) including the following case types:

• Urgent CMS casework request
• Ombudsman cases
• Media/Speaker request
• Internal Casework request

- Responsible for researching complex NGD Medicare escalations using approved websites, various exclusive CMS approved tools, and resources to provide clear answers.

- Transcribe and peer-proof Freedom of Information Act (FOIA) requests assignments with a high level of accuracy and timeliness.

- Subject matter expertise, leadership, and guidance in CCO Medicare processing activities.

- Frequent interactions and discussions with CCO department Program Manager, Managers, Call Center Supervisors, Analysts, and other Medicare ARC senior specialists.

- Identify customer service opportunities for inappropriate escalations and submit coaching suggestions for the CSR.

- Meet Service Level Agreements for escalations to the Advanced Resolution Center and internal commitments as directed by ARC Medicare leadership.

- Place outbound calls or handle inbound calls to answer Medicare questions and resolve the issue to the furthest extent possible providing knowledgeable responses in a courteous and professional manner; utilizing databases, expanded views, and scripts.

- Use treasury department's Electronic Check Processing (ECP) tool, a web-based client facing application to research missing Medicare payments.

- Correct, resubmit, track and trend inappropriately returned Medicare Administrative Contractor (MAC) escalations . Additionally, ensure ownership is transferred to the appropriate MAC.

- Research, compile data and submit Ombudsman Requests.

- Conduct 3-way calls between beneficiaries and CMS agents or partners to resolve drug plan complaints, premium issues, claims questions and other concerns.

- Maintain mastery level knowledge of Medicare ARC processes.

- Maintain appropriate documentation of phone inquiries in Next Generation Desktop (NGD) and on SharePoint Trackers.

- Meet internal and contractual commitments, assuring quality of process and direction of resources through Quality NOW platform.

- Participate in team meetings to discuss topics and trends.

- Write and proofread documents for grammatical correctness and adherence to standards and formats.

- Assist in identifying trends or conflicts within scripted information to develop and deliver new or updated scripts.

- Continually look for, and suggest, process improvements which will benefit Maximus and our customers (internal and external).

- Provide peer support and assist with delivery of internal employee nesting activities for new and temporary employees as requested.