Customer Care Representative I

Elevance Health•Wallingford, NY

7d•Hybrid

About The Position

The Customer Care Representative I is responsible for successfully completing the required basic training. Able to perform basic job functions with help from co-workers, specialists and managers on non-basic issues. Must pass the appropriate pre-employment test battery.

Requirements

Requires a HS diploma or equivalent and previous experience in an automated customer service environment; or any combination of education and experience which would provide an equivalent background.

Nice To Haves

Bilingual in Spanish, Cantonese, Mandarin, Bengali, or Russian strongly preferred
Call center experience strongly preferred
Experience in a fast-paced environment and ability to navigate multiple computer systems and learn new software strongly preferred
Strong teamwork and collaboration skills strongly preferred
Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Responsibilities

Answer inbound calls to the Member Services Department using the Plan’s standard greeting.
Respond to caller’s inquiries and resolve member, vendor, and provider requests for information and member materials.
Provide accurate information to callers regarding benefits, Member Handbook, and other requested information, as appropriate.
Research, identify, and resolve caller’s complaints using applicable resources and systems.
Warm transfer calls to appropriate individuals, as required.
Identify and escalate issues, as appropriate.
Document all call outcomes in the electronic medical record system.
Maintain and update member records with pertinent information, as necessary.
Advise Members of the Plan’s grievance and appeals processes, the service authorization process, and the Member’s right to a fair hearing and/or external review.
Develop and maintain effective working relationships with members, service providers, and all members of the care management team.
Facilitate language translation and communications assistance for callers requiring special accommodations.
Maintain knowledge of Medicaid/Medicare eligibility requirements, MLTC regulatory requirements, and internal policies and procedures.
Provide all callers with excellent customer service and handle all calls in a respectful, culturally sensitive manner.