Member Resolution Specialist, Lead

Req. Number: 1900645

City, State: Remote

Responds to all escalated member complaints received through transferred phone calls and customer service management and resolves those issues. Responsibilities also include miscellaneous special project work. Serves in a limited leadership capacity as a subject-matter-expert, mentor and coach.

Essential Functions:

  • Logs, tracks, resolves and responds to all assigned inquiries and complaints while meeting all regulatory, CMS, and WellCare Corporate guidelines in which special care is required to enhance WellCare relationships; while meeting and exceeding all performance standards.
  • Thoroughly researches issues and takes appropriate action to resolve them within turnaround time requirements and quality standards
  • Acts as a mentor for all CSR’s. Provides real-time feedback as appropriate for the job function.
  • Acts as a Subject Matter Expert (SME).
  • Works with department management to maintain daily workflow within the department in order to maximize productivity. Assists in the development of long-range goals and drives through to completion.
  • Identify root cause issues to ensure enterprise solutions and communicate findings as needed.
  • Assists Team members often guiding them to the appropriate resolution of more complex and difficult cases.
  • Acts as a liaison between internal departments on data gathering and problem solving while investigating problems of an unusual nature in the area of responsibility. Presents proposed solutions in a clear and concise manner.
  • Assists in the education of new members and in the re-education of existing members regarding health plan procedures.
  • Occasionally performs specific supervisory functions.
  • Assists with Quality Initiatives such as call monitoring and all reinforcement of quality service at the team and department levels.
  • Assists with special projects as assigned or directed

Additional Responsibilities:

Candidate Education:

  • Required A High School or GED
  • Preferred An Associate’s Degree in a related field
  • Preferred or equivalent work experience

Candidate Experience:

  • Required 3 years of experience in a call center or customer service environment
  • Required 6 months of experience in Experience in a healthcare environment

Candidate Skills:

  • Advanced Demonstrated written communication skills
  • Advanced Demonstrated interpersonal/verbal communication skills
  • Intermediate Other Ability to follow direction

About us

Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a “World’s Most Admired Company” in 2018 by Fortune magazine. For more information about WellCare, please visit the company’s website at EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.