Customer Care Resolution Specialist

CareSource; Kentucky; Hybrid; USD 65,298,000 - 104,698,000; Full time

Job summary

CareSource is seeking a Customer Care Resolution Specialist in Kentucky to serve as a subject matter expert for the assist line, handling escalated calls from members and providers. The role includes coaching new hires, identifying process gaps, and partnering with internal teams to improve service levels.

We expect a strong background in customer care, call-center experience, and knowledge of Medicaid or related health plan processes.

Qualifications

• High School diploma or equivalent required.
• Minimum of one year experience in Customer Care (Member Services or Provider Services) required.
• Minimum of three years customer service experience in a call center preferred.
• Minimum of two years of HMO or related industry experience preferred.

Responsibilities

• Act as SME, staff assist line and respond to inquiries.
• Resolve escalated calls from members and providers.
• Serve as New Hire Transition Coach for new employees.
• Identify process gaps and partner with Business Integration Team to resolve.
• Provide Peer-to-Peer feedback and identify training needs.

Skills

Customer Care processes

Deescalation skills

Problem solving

Communication skills

Team collaboration

Attention to detail

Multitasking

PHI/ HIPAA compliance

Education

High School diploma or equivalent

Job description

Job Summary

The Customer Care Resolution Specialist is responsible for being a subject matter expert and effectively handling and resolving escalated calls from members and providers.

Essential Functions

• Acts as subject matter expert, while staffing the assist line and accurately responding to inquiries presented by Customer Care Specialists
• Effectively handle and resolve escalated calls from members and providers
• Act as a New Hire Transition Coach for new employees
• Identify gaps in current processes and partner with Business Integration Team to solve those issues.
• Provide Peer to Peer feedback
• Identify training needs for Customer Care Specialists
• Manage and process incoming work from internal route boxes, incoming faxes, email, web inquiries, and ServiceNow queues
• Partner with other departments to ensure internal service levels are achieved
• Utilize self-education opportunities to stay abreast of procedural updates – maintain Subject Matter Expert (SME) status in all skill sets
• Document all second level support questions by utilizing and maintaining the Assist Line Tracking Database
• Act as a role model to other employees by displaying a positive attitude, being helpful and approachable, motivating others and being accountable for actions
• Assist members and providers with routine service inquiries
• Ensure all HIPAA and State requirements/regulations are adhered to at all times in existing and future lines of business
• Research, follow up and resolve all open/pending issues in a timely manner to ensure member satisfaction
• Maintain knowledge and understanding of, and adhere to, all processes and procedures
• May be required to create and conduct departmental training, as business needs dictate; successful completion of the CareSource University Functional Facilitator certification program is required prior to fulfilling these duties
• Perform any other job duties as requested.

Education and Experience

• High School education or equivalent required
• Minimum of one (1) year experience in Customer Care (Member Services or Provider Services) required
• Minimum of three (3) years customer service experience in a call center is preferred
• Minimum of two (2) years of HMO or related industry experience is preferred

Competencies, Knowledge and Skills

• Strong understanding of Customer Care processes
• Ability to deescalate difficult conversations
• Ability to determine root cause of problems and propose solutions
• Computer proficiency with knowledge and experience in a “Windows” environment
• Typing, 35 WPM
• Claims and Coding Experience (ICD9, CPT4, HCPCS, Revenue Code and Dental Coding)
• Excellent written and communication skills
• Professional phone etiquette
• Proper use of grammar
• Ability to work in a fast paced environment
• Adaptable to a constantly changing environment
• Attention to detail
• Ability to multitask
• Ability to work independently and with a team
• Critical thinking and listening skills
• Decision making and problem solving skills
• Ability to coach and provide feedback effectively
• Understanding of Medicaid

Working Conditions

General office environment; may be required to sit or stand for extended periods of time

Must adhere to an assigned daily work schedule and have predictable and reliable attendance

Compensation

Compensation Range: $47,400.00 - $76,000.00

Compensation Type (hourly/salary): Hourly

In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Organization Level Competencies

• Fostering a Collaborative Workplace Culture
• Cultivate Partnerships
• Develop Self and Others
• Drive Execution
• Influence Others
• Pursue Personal Excellence
• Understand the Business

Company Culture

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time.

CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

The CareSource mission is known as our heartbeat. Just as we support our members to be the best version of themselves, our employees are driven by our mission to create a better world for members, stakeholders and providers. We are difference‑makers who combine compassionate hearts with our unique business expertise to make every opportunity count. Each claim, each phone call, each consumer‑centric decision is a chance to change the world for one member, and our employees look for ways to do that every day. The challenge is, there is no one right way to be the difference and we’re looking for people like you that will rewrite that definition every day. We do what it takes to form creative solutions that make our community and the world just a little better. Discover what it means to be #UniquelyCareSource.