Lead Customer Service Representative

The onsite Member Experience & Engagement Lead is a subject matter expert in the health care experience our members navigate daily. They support the inbound and/or outbound call experience while also assisting and accelerating the performance of their team unit. The Lead helps ensure team members possess the skills and training necessary through daily performance monitoring as it pertains to production, quality, and service to ensure that company goals and departmental metrics are met. General Duties / Responsibilities Acts as the subject matter expert for procedures, protocols, benefits, services, and any other necessary information to resolve member issues and inquiries. Leads any specific projects, products, regions, or other specializations as assigned, including complex or VIP member issues. Assumes the tier two role that includes answering incoming member phone calls within the department’s goal time frame, and conducting outbound member phone calls in accordance with the department’s productivity metrics and goals. Address complaints against the health plan and its contracted facilities according to applicable complaint or grievance procedure. Assists in defining and monitoring performance and productivity standards. Assists with the onboarding of entry level staff including but not limited to ‘nesting’ and quality assurance of live call monitoring during the training period as required. Collaborates with the Trainer and QA Specialist in identifying training needs; participates in regular meetings with management to report call trends and identify opportunities for team improvement. Maintains confidentiality and upholds standards for privacy, data integrity, and security. Encourages a spirit of cooperation, teamwork, and accountability among all department employees. Performs other duties as assigned. Minimum Requirements Experience: Minimum three (3) years of customer service experience. Preferred: 5+ years customer service experience, healthcare experience, and previous Lead experience. Education: High School Diploma or GED required. College courses preferred. Specialized Skills: Knowledge of Medicare Managed Care Plans; 40+ words per minute typing and 10‑key touch; strong communication skills; leadership and teaching ability; constructive relationships with diverse members, management, employees and vendors. Mathematical Skills: Add, subtract, multiply, and divide two‑digit numbers using units of American money, weight, volume, and distance. Reasoning Skills: Apply common sense to carry out detailed instructions, solve problems with concrete variables, and use advanced reasoning to define problems, collect data and design solutions. Problem‑Solving Skills: Effective problem solving, organizational and time‑management skills, and ability to work in a fast‑paced environment. Language: Bi‑lingual (English/Spanish) preferred. Licensure: None required. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this job. The noise level in the work environment is usually moderate. Essential Physical Functions: The employee is regularly required to sit; use hands to finger, handle, or feel, and talk or hear. Frequently required to walk, stand, reach with hands and arms. Occasionally required to climb or balance, stoop, kneel, crouch, or crawl. Must occasionally lift and/or move up to 20 pounds. Specific vision abilities include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus. Pay Range: $44,790.00 - $67,185.00 (may be based on market location, education, responsibilities, experience, etc.). Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation. #J-18808-Ljbffr