Customer Care Representative

Responsibilities

• Answer inbound calls to the Member Services Department using the Plan’s standard greeting.
• Respond to caller’s inquiries and resolve member, vendor, and provider requests for information and member materials.
• Provide accurate information to callers regarding benefits, Member Handbook, and other requested information.
• Research, identify, and resolve caller’s complaints using applicable resources and systems.
• Warm transfer calls to appropriate individuals, as required.
• Identify and escalated issues, as appropriate.
• Document all call outcomes in the electronic medical record system.
• Maintain and update member records with pertinent information, as necessary.
• Advise Members of the Plan’s grievance and appeals processes, the service authorization process, and the Member’s right to a fair hearing and/or external review.
• Develop and maintain effective working relationships with members, service providers, and all members of the care management team.
• Facilitate language translation and communications assistance for callers requiring special accommodations.

• Requires a HS diploma or equivalent.
• previous experience in an automated customer service environment
• Bilingual in Spanish, Cantonese, Mandarin, Bengali, or Russian strongly preferred
• Call center experience strongly preferred
• Experience in a fast-paced environment
• Ability to navigate multiple computer systems and learn new software
• Strong teamwork and collaboration skills