An Executive Response Specialist is needed for a major managed care company 100% Remote
– can sit anywhere but will need to work M-F 8 AM
– 5 PM EST $17.00/hr Day to Day Responsibilities of this Position and Description of Project: Research and resolve all escalations from WellCare members/providers that are addressed to Centene/WellCare Executive Offices, Executive Leadership Team or the CEO (Presidential) as well as complaints coming from the Attorney General, State officials, and other internal areas for final resolution in a professional, timely, accurate and caring manner.
Executive Response Specialist II are part of the Service Escalation Unit (SEU) team who handle the highest level of escalated issues within the organization for all lines of business (Medicare, Medicaid, PDP and Exchange) Resolves and responds to the most highly escalated issues coming from other escalated areas such as Customer Service, MET, Grievances, and other areas for final resolution.
The Executive Response Specialist II are Subject Matter Experts in all lines of business who handle and resolve the most highly escalated complaints and issues received via email, mail correspondence, and inbound/outbound phone calls on behalf of our Executive Leadership Team while maintaining the highest standard of quality on every call.
Also handles and resolves escalated complaints and issues received from members, providers, Governing bodies, Regulatory Agencies, FL Ombudsman, Better Business Bureau, Department of Health, Department of Insurance, Attorney General, Social Media, Centene/WellCare Legal Department, and Centene/WellCare Corporate Compliance Department.
All calls are monitored for quality and training purposes.
Logs, tracks, resolves and responds to all assigned complaints and inquires in writing and/or by telephone, while meeting all regulatory, and Centene/WellCare Corporate guidelines in which special care is required to maintain customer satisfaction.
Executive Response Specialist II represents our CEO and Corporate office when responding to these complaints in a professional manner seeking a win/win for all parties while respecting sound business and health management practices.
Effectively assists in the education of new members and in the re-education of existing members regarding health plan procedures.
Thoroughly research and effectively communicates with our members regarding the resolution of their inquiries, complaints and issues with a professional demeanor in a clear, articulate, and timely manner while demonstrating a strong understanding of the issues.
Work with providers to correct billing and claim issues and educate providers on how to eliminate problems going forward.
Act as a liaison between internal departments and external partners on data gathering and problem solving by investigating all issues of an unusual nature in the area of responsibility.
Present proposed solutions in a clear and concise manner.
Identify trends, monitor the root cause of member/provider issues, and work cross functionally with all departments to ensure enterprise wide solutions.
Efficiently and effectively, maintain a high caseload while meeting and exceeding all performance standards Job Requirements: Education/Experience: High school diploma or equivalent.
Associates degree preferred.
0-2 years of experience