The incumbent in this position acts as a subject matter expert (SME) in assigned unit, fields questions from staff, is able to provide appropriate issue resolution and escalation when needed. Assists the Supervisor/Manager with escalations, complaints, coaching, on-the-job training, monitoring work, mentoring new associates and driving results. This position may also serve as a back-up in production. Works with other departments to identify areas of opportunity/performance improvement and recommend solutions.
• Act as first point of contact for escalated calls
• Manages payer, provider and patient complaint resolution and be proficient with entering information into CART system
• Recognize associates for strong performance and demonstrating the company Mission – Vision – Values
• Identify opportunities to improve provider experience
• Monitor phone queues and partner with the Global Command Center (GCC) to meet service goals
• Monitor offline work for quality and to meet service goals
• Monitor and/or complete production, as applicable
• Works with supervisors and staff employees to drive efficient call volume activity and management.
• Work with supervisors to create efficient work plans and and update employee scorecards
• Maintain Daily Boards updates-metrics, messages
• Supports cross-functional process improvement efforts
• Reviews and adheres to all Company policies and procedures and the Employee Handbook
• Other duties as assigned
• Promote staff reliability
• Encourage frequent communication among all staff members
• Must respond to calls/e-mails in a timely manner
• Respond and attend required meetings
• Projects/spreadsheets – across all operations
• Act as a resource for Customer Service Representatives, line staff-research process issues
• Monitor sensitive State Reports
• Ensure operational policies are met
High School Diploma/GED or two years of customer service, claims processing, medical terminology, medical services or equivalent experience required. Two years of experience in a CareCentrix Operations role is preferred. Knowledge of basic spreadsheet, word processing, and data entry with speed and accuracy is required. Has expert knowledge of department systems and processes, CareCentrix business protocols and regulatory knowledge. Ability to lead by example is also required.
This position requires excellent communication, customer service and analytical skills as well as the ability to interact with all levels of management and a highly diverse population. Must have strong organizational skills and be able to effectively manage and prioritize multiple tasks. Must be able to problem-solve difficult situations with internal and external customers and with process and/or systems issues. Convey a strong professional image, exhibit interest and positive attitude toward all assigned work. Must be detail oriented, be responsive, and demonstrate independent thought, problem solving and critical thinking. Must be able to demonstrate leadership qualities with the staff they are assisting.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
Prefer one year or more experience within the Network Services team with above average performance. KPI scorecard metrics met 8 of 10 months. Proficient in 1.0 and 2.0 claims platform and all communication channels supported by the Network Services team (inbound/outbound calls, emails, portal inquiries, etc).
CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.