Participant Experience Specialist

St Pauls Senior Services•SAN DIEGO, CA

12h

About The Position

The Participant Experience Specialist provides excellent telephonic customer service to both participants and providers within a healthcare setting. This role is responsible for addressing inquiries, resolving concerns in a timely and effective manner, and collaborating with other departments as needed to ensure high-quality service. The representative maintains accurate records of interactions, redirects calls appropriately, and ensures all communications are handled with professionalism and care.

Requirements

High school diploma or equivalent; Bachelor’s degree preferred.
Previous experience in a call center or customer service role, preferably in healthcare or related field.
Minimum of one year’s experience working with the frail or elderly.

Responsibilities

Manages incoming calls from participants who may be experiencing pain, illness or are managing other health-related concerns, often seeking assistance with appointments, medications, or care coordination.
Determines the nature of the incoming telephone calls, channels all incoming calls and routes calls to appropriate departments, as needed.
Provides courteous and professional customer service via telephone to participants and providers.
Responds to inquiries and provides information about agency services to participants, families, outside agencies, and the general public, while resolving issues and escalating concerns as needed.
Collaborates effectively with internal teams and healthcare professionals to ensure a unified, comprehensive, and seamless approach to member support.
Maintains detailed and accurate records of all calls and interactions while ensuring the confidentiality of company procedures, results, and information related to participants, clients, or families.
Follows established protocols and procedures to ensure compliance with quality standards, while consistently meeting performance metrics related to call handling, customer satisfaction, and documentation.
Exercises independent decision-making with minimal oversight, confidently managing responsibilities in alignment with organizational goals, while applying advanced problem-solving skills to navigate complex situations and drive continuous improvement in service quality.
Manages calls that may involve urgent or time-sensitive healthcare needs, requiring quick thinking and effective communication, as well as calls from providers requesting information, clarification on procedures, or coordination of services.
Performs other duties as required or requested.