Case Resolution Specialist I

FreedomCare•Pittsburgh, PA

17h•Hybrid

About The Position

FreedomCare is a healthcare company founded in 2016 that provides consumer-directed home care. The Case Resolution Specialist I is a customer-centric, field-based position on the Pennsylvania team, with a required commute to the Pittsburgh office 2–3 days per week. The role partners with patients and health plans to resolve issues preventing patients from continuing services, and helps former patients restore homecare services. It combines patient and caregiver intake and onboarding activities, providing a single point of contact during their transition back to the program. The specialist guides patients and caregivers through application, enrollment, and service restoration; coordinates with health plans and other medical providers; and works across internal teams to help ensure services are authorized and can resume efficiently. The role requires high-volume customer contact, careful case documentation, timely follow-up, and achievement of enrollment, call-handling, and other performance metrics.

Requirements

At least 2 years of experience in a high-volume inbound call center or contact center environment.
Previous experience in a customer service environment.
Experience managing a high volume of inbound and outbound calls.
Strong customer-service skills, including empathy, active listening, and patience.
Ability to document case statuses in detail using Salesforce.
Computer proficiency, strong typing skills, and ability to use technology to resolve customer issues while multitasking and taking notes.
Ability to organize, set priorities, and manage time effectively.
Strong verbal and written communication skills, with the ability to adapt to different personality types.
Ability to resolve issues over the telephone and successfully de-escalate frustrated callers.
Attention to detail when reviewing records.
Ability to meet or exceed targets and performance metrics.

Nice To Haves

Two years of relevant experience in a similar position.
Bilingual ability in Spanish or other languages.
Salesforce proficiency.
Familiarity with Pennsylvania Medicaid and health plans.

Responsibilities

Provide high-level customer service and resolve issues through one-call resolution, demonstrating empathy and a positive, helpful demeanor.
Meet monthly performance metrics related to starting patients on care and handling calls.
Serve as the primary point of contact for patients and caregivers restoring services, and coach them through the program application and enrollment process.
Respond to emails, chat messages, and voicemails within one business day.
Enroll at least 22 patients and caregivers per month in FreedomCare’s Pennsylvania homecare program.
Handle inbound and outbound calls with potential patients and caregivers while maintaining high-quality customer service.
Use systems such as e-Paces and health plan portals to determine eligibility and obtain authorizations.
Maintain detailed patient and caregiver case notes.
Enroll valid leads who are interested in the program and align consumers with caregivers seeking additional hours.
Help patients and caregivers complete the process of restoring services.
Communicate with patients, caregivers, and health plans to ensure the restoration process is completed.
Contact patients with updates and keep them informed about the status of the process.
Work with Intake, Care Teams, and other departments to keep patients and caregivers engaged and help them get value from services.
Meet daily, weekly, and monthly metrics and call requirements so patients can resume services.
Help patients troubleshoot and resolve Medicaid-related issues, and educate patients and caregivers about onboarding.
Work with health plans to obtain authorizations and ensure required paperwork is on file and up to date.
Provide documentation and requirements to Pennsylvania’s State Department of Health, patients’ insurance, and caregivers so services can be authorized efficiently.
Coordinate with other medical providers to ensure documentation for potential patients and caregivers is compliant.