Customer Care Resolution Specialist
Core
Subject matter expert handling escalated calls from members and providers, acting as a second-level support resource and coach for new hires.
Role type
Senior IC customer care resolution specialist
Builds
Resolved member and provider service issues
Domain
Healthcare (HMO/Medicaid)
Deliverable
client delivery
Required skills
Claims and coding (ICD9, CPT4, HCPCS, Revenue Code, Dental), HIPAA compliance, de-escalation, root cause analysis, coaching, Medicaid knowledge
Preferred skills
3+ years call center experience, 2+ years HMO experience
Technologies
ServiceNow, Windows environment
Responsibilities
Handle and resolve escalated calls from members and providers; Act as a New Hire Transition Coach; Identify process gaps and partner with Business Integration Team; Manage incoming work from internal route boxes, faxes, email, web inquiries, and ServiceNow queues; Document second-level support questions in the Assist Line Tracking Database; Conduct departmental training if required
Seniority
Mid-level, hands-on IC