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 escalate 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

Customer Care Representative

Key skills