Customer Care Resolution Specialist

This is a fully remote position, open to applicants in Ohio.

📋 Description

• Act as a subject matter expert while managing the assist line and providing accurate responses to inquiries from Customer Care Specialists.

• Address and resolve escalated calls from both members and providers.

• Serve as a New Hire Transition Coach for newly onboarded employees.

• Identify process inefficiencies and collaborate with the Business Integration Team to address them.

• Offer peer-to-peer feedback and pinpoint training needs for Customer Care Specialists.

• Oversee and manage incoming work from route boxes, faxes, emails, web inquiries, and ServiceNow queues.

• Collaborate with other departments to meet internal service level agreements.

• Maintain subject matter expert status through continuous education and procedural updates.

• Record second-level support inquiries in the Assist Line Tracking Database.

• Assist members and providers with standard service inquiries.

• Investigate, follow up on, and resolve outstanding or pending issues.

• Develop and deliver departmental training as needed following the completion of CareSource University Functional Facilitator certification.

• Perform additional duties as assigned.

⛳️ Requirements

• High School diploma or equivalent is required.

• At least one (1) year of experience in Customer Care (Member Services or Provider Services) is required.

• A minimum of three (3) years of customer service experience in a call center is preferred.

• At least two (2) years of experience in HMO or a related industry is preferred.

• Strong grasp of Customer Care processes.

• Ability to deescalate challenging conversations.

• Capability to identify the root cause of issues and suggest solutions.

• Proficiency in computer usage with experience in a Windows environment.

• Typing proficiency of 35 WPM.

• Experience with Claims and Coding (ICD9, CPT4, HCPCS, Revenue Code, and Dental Coding).

• Exceptional written and verbal communication skills.

• Professional phone etiquette.

• Proper grammar usage.

• Ability to thrive in a fast-paced environment.

• Flexibility to adapt to a continually evolving environment.

• Strong attention to detail.

• Capability to multitask effectively.

• Ability to work both independently and collaboratively within a team.

• Strong critical thinking and listening abilities.

• Decision-making and problem-solving skills.

• Proficiency in coaching and providing constructive feedback.

• Understanding of Medicaid.

• Must adhere to a designated daily work schedule and maintain consistent and reliable attendance.

• Must comply with all HIPAA and State regulations/requirements.

🏝️ Benefits

• Bonus opportunities linked to both company and individual performance may be available.

• Extensive and comprehensive total rewards package.

• Support for employee total well-being.