Customer Solution Representative job vacancy

Vacancy expired!

Answers incoming calls from members, potential members, providers, and advocates.
Handles and resolves member issues or assists members in connecting with internal units or external parties such as Plan Partners, Primary Care Physician (PCP) offices, pharmacists, etc.
Provides essential information to members regarding access to care issues, coordination of care issues, benefits, Evidence of Coverage (EOC), Member Handbook, etc. and assist providers in using the Interactive Voice Response (IVR), web portals, and verifying member eligibility.
Document all calls in the system of record Performs the completion of PCP transfers.
Process plan partner changes. (50%) Verifies eligibility for Plan Partners, Providers and Members.
Assists Management with projects as needed; assist with new hire shadowing. Works with Member Relations Specialist to assist members with complex issues and coordination of care issues within Plan Partners. Trouble shoots and directs calls to the appropriate departments.
Handles complex call center calls. (30%)
Participate in Quality Scorecard Training and implement recommendations for improvement based on scorecard results. Check call center voicemail box as needed. (10%) Performs other duties as assigned. (10%)