Customer Care Resolution Specialist
Budget / Salary$47,400–76,000
TypeFull-time job
LocationUnited States
Posted2 hours ago
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:
$47,400.00 - $76,000.00CareSource 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):
HourlyOrganization 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.
Brand=CareSourceOriginally posted on Himalayas
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:
$47,400.00 - $76,000.00CareSource 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):
HourlyOrganization 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.
Brand=CareSourceOriginally posted on Himalayas
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