Customer Care Resolution Specialist

CareSource•Ohio WFH, OH

1d•$47,400 - $76,000•Onsite

About The Position

The Customer Care Resolution Specialist is responsible for being a subject matter expert and effectively handling and resolving escalated calls from members and providers. This role acts as a subject matter expert for the assist line, accurately responding to inquiries from Customer Care Specialists. The specialist will also serve as a New Hire Transition Coach, identify process gaps and collaborate with the Business Integration Team to resolve them, and provide peer-to-peer feedback. Additionally, they will identify training needs for Customer Care Specialists, manage incoming work from various internal channels, and partner with other departments to ensure internal service levels are met. Continuous self-education is expected to maintain Subject Matter Expert (SME) status. The role involves documenting second-level support questions in the Assist Line Tracking Database, acting as a role model with a positive attitude, assisting with routine service inquiries, and ensuring adherence to HIPAA and State requirements. The specialist will research, follow up, and resolve open issues to ensure member satisfaction, maintain knowledge of all processes and procedures, and may be required to create and conduct departmental training after completing the CareSource University Functional Facilitator certification. Any other job duties as requested will also be performed.

Requirements

High School education or equivalent required
Minimum of one (1) year experience in Customer Care (Member Services or Provider Services) required
Typing, 35 WPM
Excellent written and communication skills
Professional phone etiquette
Proper use of grammar
Ability to work in a fast paced environment
Adaptable to a constantly changing environment
Attention to detail
Ability to multitask
Ability to work independently and with a team
Critical thinking and listening skills
Decision making and problem solving skills
Ability to coach and provide feedback effectively

Nice To Haves

Minimum of three (3) years customer service experience in a call center is preferred
Minimum of two (2) years of HMO or related industry experience is preferred
Strong understanding of Customer Care processes
Ability to deescalate difficult conversations
Ability to determine root cause of problems and propose solutions
Computer proficiency with knowledge and experience in a “Windows” environment
Claims and Coding Experience (ICD9, CPT4, HCPCS, Revenue Code and Dental Coding)
Understanding of Medicaid

Responsibilities

Acts as subject matter expert, while staffing the assist line and accurately responding to inquiries presented by Customer Care Specialists
Effectively handle and resolve escalated calls from members and providers
Act as a New Hire Transition Coach for new employees
Identify gaps in current processes and partner with Business Integration Team to solve those issues.
Provide Peer to Peer feedback
Identify training needs for Customer Care Specialists
Manage and process incoming work from internal route boxes, incoming faxes, email, web inquires, and ServiceNow queues
Partner with other departments to ensure internal service levels are achieved
Utilize self-education opportunities to stay abreast of procedural updates – maintain Subject Matter Expert (SME) status in all skill sets
Document all second level support questions by utilizing and maintaining the Assist Line Tracking Database
Act as a role model to other employees by displaying a positive attitude, being helpful and approachable, motivating others and being accountable for actions
Assist members and providers with routine service inquires
Ensure all HIPAA and State requirements/regulations are adhered to at all times in existing and future lines of business
Research, follow up and resolve all open/pending issues in a timely manner to ensure member satisfaction
Maintain knowledge and understanding of, and adhere to, all processes and procedures
May be required to create and conduct departmental training, as business needs dictate; successful completion of the CareSource University Functional Facilitator certification program is required prior to fulfilling these duties
Perform any other job duties as requested