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…