Job Description

Position Purpose:
Serves as the first-line advocate that focuses on resolving inquiries, issues, or concerns for members and/or providers. Leverages a variety of communication channels to provide members and/or providers with timely, accurate, and personalized support on routine complaints.


Education/Experience:
Requires a High School diploma or GED
Entry-level position typically requiring little or no previous experience


Experience interacting and multitasking using multiple systems and programs simultaneously preferred.


Receives and responds to routine member and/or provider inquiries, requests and/or concerns in an accurate and timely manner


Mitigates and prevents complaints from being escalated to resolve in initial contact


Serves as the front-line resolution advocate on various member and/or provider inquiries, requests, or concerns


Resolves basic problems by communicating the requested information regarding the assessment of the member or provider needs, understanding the cause, and determining if problems need to be routed to other departments for further resolution


Maintains performance and quality standards based on established contact center metrics


Provides customer service in a high pace contact center environment over the phone, via live chats and emails


Documents all member or provider information and communications for quality and performance tracking through the Customer Relationship Management (CRM) applications


Remains up-to-date and adheres to quality standards, regulation, and all other policies to ensure quality, consistency, and compliance
Performs other duties as assigned


Complies with all policies and standards

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