POSITION SUMMARY
This position provides leadership and expertise to the representatives providing customer service to providers and members of benefit plans; supports the development of the company health plans as well as the staff by coordinating the training, documentation, client communication techniques, and other resources necessary to ensure an excellent quality of service. This position serves as a primary resource in complex and/or sensitive cases and takes escalated calls. May be assigned to work in a variety of team leadership, work flow management and/or quality assurance functions.

CORE FUNCTIONS
1. Provides customer service, researches and solves problems for escalated calls and member or provider issues requiring investigation and problem solving.

2. Provides training and informational/reference resources for the service center.

3. Maintains records, tracks cases, issues correspondence and log events for assigned area of benefits services.

4. Provides direction and leadership in daily work and workflow of a service center team.

5. Works on special projects as assigned.

7. Works under limited supervision to provide for diverse customer service needs for multiple benefit plans. Interprets company and contracted managed care organization policy and procedure. Makes decisions within structured definitions and defined policy. This position manages diverse customer needs while positioning services and programs as the preferred choice for meeting the stated needs. This position independently interprets benefits and managed care policies and procedures and communicates accordingly to customer base, following general guidelines and standards, this position will determine appropriate action to meet customer needs.

MINIMUM QUALIFICATIONS

High school diploma/GED or equivalent working knowledge.

Must have substantial previous related work experience in managed care benefits member/provider services work are required, with three to fours years of experience in a high volume service center or managed care environment, preferably with self-insured plans.

Must possess excellent communication skills to handle moderately complex inquiries, while maintaining a positive and helpful attitude. Requires the ability to handle a high volume of incoming calls, search the database or resources tools for correct and timely information, and maintain a professional demeanor all times. Must have the ability to learn and effectively use the company’s customer information systems, as well as developing and maintaining a fundamental knowledge of the organization’s benefit plans.

PREFERRED QUALIFICATIONS

Experience working with self insured plans is highly preferred. Bilingual Spanish/English skills are a plus.

Additional related education and/or experience preferred.