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You will handle advanced and escalated inquiries by researching complex issues and collaborating across teams to provide accurate resolutions. Additionally, you will identify operational trends, support internal stakeholders, and ensure service delivery meets quality and compliance standards.
Essential Duties and Responsibilities
- Respond effectively to inbound and outbound customer, provider, or stakeholder contacts via telephone, Interactive Voice Response (IVR), written correspondence, or system workflows.
- Provide accurate, unbiased information regarding eligibility, enrollment, services, and program requirements across multiple contract programs.
- Investigate, analyze, and resolve complex or escalated issues originating from multiple service channels, including contact center, operations, research, and interface processes.
- Research beneficiary or case history, interpret data from multiple systems, and report findings or recommendations to management as needed.
- Process enrollment, disenrollment, and other program transactions in accordance with established production, quality, and compliance standards.
- Access, read, and interpret customer, beneficiary, provider, and system data elements to support issue resolution.
- Maintain up to date knowledge of programs, policies, procedures, and contract compliance requirements and apply them accurately to case resolution.
- Serve as a liaison or support resource for internal teams, health plans, or external partners by researching inquiries and coordinating resolution efforts.
- Provide backup support to operational functions as needed, which may include contact center operations, forms processing, research, interface tracking, or mailroom support.
- Anticipate potential issues, identify trends or risks affecting operations or service delivery, and proactively escalate concerns to management.
- Provide feedback to leadership regarding staff performance, training needs, or process gaps.
- Recommend procedural, workflow, or process improvements to enhance accuracy, efficiency, and compliance.
- Review knowledge base content, reference materials, or system documentation and make recommendations for updates or improvements.
- Participate in special projects, audits, or initiatives as assigned.
- Support the development and delivery of training or knowledge sharing activities when needed.
- Establish and maintain effective working relationships with internal teams, supervisors, and external partners.
- Meet or exceed established productivity, quality assurance, and performance standards.
- Maintain confidentiality and security of customer, provider, and program information at all times.
- Perform other related duties as assigned by management.
- Call Center service experience preferred
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