Essential Duties and Responsibilities:
- Interface with clients and refer complaints or inquiries to appropriate departments agencies advocates or client representatives.
- Stay updated on managed care relevant to supported client programs.
- Adhere to processing guidelines protocols and contract requirements for complaint processing and handling PHI/PII.
- Assist consumers in health plan enrollment disenrollment and transfers when necessary.
- Fulfill assigned duties directed by the Complaint Unit Supervisor or Project Management.
- Meet performance standards outlined in the annual criteria and bonus template for the position.
- Address complex customer service inquiries and problems over the telephone noting consistent issues for resolution.
- Potentially respond to email inquiries.
- Prioritize customer service as the primary function handling non-routine calls requiring deviation from standard procedures.
- Manage situations needing adapted responses or extensive research based on customer needs.
- Utilize computerized systems for tracking information gathering and troubleshooting.
- Handle escalated or unresolved calls from less experienced representatives.
- Tackle moderately difficult assignments exercising judgment in issue resolution and recommending solutions.
At Maximus Management Training Center, we create an environment where we aim to deliver high quality education and training that responds to the needs of employers and individuals.