Voice of the Customer Specialist (Escalations)

Ametros; Wilmington (DE); Remote; USD 33,062 - 35,817; Full time

Benefits offered by this job

Diversity and Inclusion Initiatives

Philanthropic Initiatives

Job summary

An innovative firm is seeking a Voice of the Customer Specialist to enhance member satisfaction through effective complaint resolution. This role involves managing escalated issues, utilizing CRM tools, and collaborating with various departments to ensure positive outcomes. The ideal candidate will thrive in a fast-paced environment and possess excellent communication skills, along with a passion for helping others. Join a team that values diversity and inclusion while transforming the healthcare experience for individuals. If you are ready to make a difference, this opportunity is for you!

Qualifications

• 3+ years in call center managing escalated calls.
• Excellent communication and problem-solving skills.
• Healthcare experience preferred.

Responsibilities

• Resolve member complaints and document escalated issues.
• Manage casework queues in CRM tools.
• Collaborate with departments to gather information.

Skills

Inbound/Outbound Call Management

Conflict Resolution

Communication Skills

Microsoft Office

CRM Systems (Microsoft Dynamics, Salesforce)

Active Listening

Critical Thinking

Healthcare Knowledge

Tools

Microsoft Dynamics

Salesforce

Job description

Description

Ametros is changing the way individuals navigate healthcare by providing them with the tools and support necessary to make educated decisions on how to spend their medical funds. Our team works closely with patients, insurers, employers, attorneys, brokers, medical providers, and Medicare to create a seamless experience. Our flagship product revolutionizes the administration of funds from insurance claim settlements post-settlement. We continue to innovate, bringing new solutions to simplify healthcare management, making it safe, effortless, and cost-effective for everyone.

Position: Voice of the Customer Specialist

We are seeking a Voice of the Customer Specialist responsible for handling escalated member concerns and complaints professionally and promptly, ensuring positive outcomes. The role involves researching and resolving complex member interactions and issues. The ideal candidate should have knowledge of medical and behavioral health and be skilled in managing member relationships to enhance loyalty and satisfaction.

Primary Tasks:

1. Resolve member complaints and escalated issues, ensuring satisfactory outcomes.
2. Document and track escalated issues, maintaining clear records from start to finish.
3. Manage casework queues in CRM tools like Microsoft Dynamics.
4. Research account history, notes, treatment plans, and settlement documents to identify root causes and devise solutions.
5. Collaborate with Claims, Rx, and Sales departments to gather information and coordinate efforts.
6. Manage inbound call volume.
7. Reach out to providers, pharmacies, and members for additional information.
8. Develop strategies to reduce escalated issues by analyzing trends and patterns.
9. Demonstrate problem-solving skills and critical thinking in resolving complaints.
10. Communicate effectively with members and internal teams.
11. Explain coverage determinations clearly.
12. Identify and suggest ways to empower the Member Care team through ownership and connection building.
13. Stay updated on policies and procedures, suggesting modifications as needed.
14. Share insights for learning and improvement based on trend analysis.

Required Skills and Qualifications:

1. 3+ years in an inbound/outbound call center, managing complex or escalated calls.
2. Passion for helping others and resolving member issues.
3. Excellent communication skills, both written and verbal.
4. Experience with Microsoft Office and CRM systems like Microsoft Dynamics or Salesforce.
5. Active listening and critical thinking abilities.
6. Proven track record in managing multiple escalations and following up timely.
7. Ability to thrive in a fast-paced environment.
8. Healthcare experience and knowledge of claims processing are a plus.

The estimated salary range is $24.00-$26.00 per hour, with potential variation based on experience and location. The role is eligible for incentive compensation.

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Additional Information

Employees can participate in engagement, diversity, and philanthropic initiatives from day one, supporting our goal of Limitless Inclusion for All. As Ametros Citizens, we foster an inclusive environment that celebrates diverse backgrounds and voices, driving innovation and industry transformation.

Ametros is an Equal Opportunity Employer.