Customer Care Resolution Specialist

Job Summary:

The Customer Care Resolution Specialist is responsible for being a subject matter expert and effectively handling and resolving escalated calls from members and providers.

Essential Functions:

• 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

Education and Experience:

• High School education or equivalent required
• Minimum of one (1) year experience in Customer Care  (Member Services or Provider Services) required
• 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

Competencies, Knowledge and Skills:

• 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
• Typing, 35 WPM
• Claims and Coding Experience (ICD9, CPT4, HCPCS, Revenue Code and Dental Coding)
• 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
• Understanding of Medicaid

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Must adhere to an assigned daily work schedule and have predictable and reliable attendance

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.