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Customer Service Representative
at WellCare Health Plans
Kapolei, HI

Customer Service Representative
at WellCare Health Plans
Kapolei, HI

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Description

Responds to member and provider inquiries (phone, written or walk in) regarding all aspects of WellCare business, including claims, in a professional, timely, accurate and caring manner while consistently meeting all guidelines.

Reports To: Supervisor, Customer Service

Department: Ops-Provider Communication

Level: 05

Location: Telecommute Opportunity - Must live in Hawaiian Islands

Telecommute opportunity if you live in HI.

Essential Functions:
  • Responds to member, provider and other inquiries via telephone, correspondence or lobby walk-in while meeting all corporate guidelines and performance standards.
  • Demonstrates appropriate customer-care skills such as empathy, active listening, courtesy, politeness, helpfulness and other skills as identified.
  • Records, investigates and resolves member complaints as detailed in the Grievance Procedure narrative.
  • Assists in the education of new members and in the re-education of existing members regarding health plan procedures.
  • Logs, tracks and appropriately documents all issues utilizing on-line systems and procedures, and in accordance with all applicable guidelines and requirements.
  • Makes decisions that are consistent with the concept of a win-win-win for members, associates and WellCare.
  • Demonstrates based behaviors such as initiative, accountability and value.
  • Performs skills necessary to create a high-quality customer experience, as reflected through acceptable C-Sat scores, quality monitors and member feedback.

Education: High School Diploma
Experience: 6 months to 1 year practical work experience
Previous experience in a call center or customer service environment (preferred)
Licenses/Certifications: Customer service, quality or training certifications (preferred)
Special Skills (e.g. 2nd language):
Strong written and verbal communication skills and an ability to work with people from diverse backgrounds
Ability to multi-task, good organizational and time management skills
Ability to act on feedback provided by showing ownership of his or her own development
Ability to read, analyze, and interpret verbal and written instructions
Ability to write business correspondence
Ability to effectively present information and respond to questions from members
Ability to define problems, collect data, establish facts and draw valid conclusions
Seeks to build trust, respect and credibility with all partners through full, honest, consistent, and coordinated communication
Technical Skills/Requirements:
Knowledge of email systems such as Microsoft Outlook sufficient to communicate with both internal and external contacts
Knowledge of Word and/or Excel sufficient to enter data

About us
Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.

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