Voice of the Customer Specialist (Escalations - Bilingual Preferred)

Ametros

10d•$24 - $26•Remote

About The Position

Ametros is changing the way individuals navigate healthcare by providing them with the tools and support necessary to make educated decisions on how to spend their medical funds. Ametros's team works closely with patients, insurers, employers, attorneys, brokers, medical providers, and Medicare to create a seamless experience for our clients. Our flagship product is revolutionizing the way funds from insurance claim settlements are administered after settlement. Ametros continues to innovate, bringing new solutions to the market with the goal of simplifying healthcare for our clients. We make managing medical funds safe, effortless, and cost effective for everyone. We are seeking a Voice of the Customer Specialist to be primarily responsible for handling escalated member concerns and complaints in a timely and professional manner, ensuring a positive outcome. This role involves researching and resolving escalated member interactions, complex issues, and/or complaints. The ideal candidate should have knowledge of medical and behavioral health Additionally, the VoC Specialist must be skilled in managing member relationships to enhance loyalty and satisfaction.

Requirements

3+ years’ experience in an inbound/outbound call center environment, with a focus on complex or escalated call management.
Passion for helping other people and finding the best possible resolutions for members.
Excellent written and verbal communication skills.
Experience working in Microsoft Office and CRM Systems, including Microsoft Dynamics or Salesforce.
Ability to actively listen to members and think critically to identify solutions.
History of success in tracking and managing multiple escalations, with providing follow up to members in a timely manner.
Ability to work in a fast-paced and quickly evolving office environment.

Nice To Haves

Healthcare experience with knowledge of claims processing is a plus.

Responsibilities

Resolve member complaints and escalated issues, ensuring a satisfactory outcome.
Document and track escalated issues, maintaining clear and comprehensive records from initiation to resolution.
Manage casework queues in Customer Relationship Management tool (Microsoft Dynamics).
Research account history, notes, treatment plans and settlement documents to identify escalation root cause and devise positive outcomes.
Consult with various departments including Claims, Rx and Sales to gather information and coordinate efforts in devising effective solutions.
Manage inbound call volume.
Outreach to providers, pharmacies, and members to obtain additional information as needed.
Develop and implement strategies to reduce the volume of escalated issues by identifying drivers, patterns, and trends.
Demonstrate proficiency in problem-solving and thinking critically when it comes to resolving member complaints.
Communicate effectively with members, internal teams, and management.
Ability to explain coverage determinations.
Identify and recommend ways in which our Member Care team can further build connections through empowerment and ownership.
Ensure familiarity with the most up-to-date policies and procedures and recognize potential additions or modifications as needed.
Share opportunities for learning and development on member issues and potential improvements based on trend analysis with management and other team members.