Member Services Escalation Specialist

Job Description

Job Description

JOB DESCRIPTION

JOB TITLE: Member Services Escalation Specialist FLSA STATUS: Non-Exempt

DEPARTMENT: Customer Service

REPORTS TO: Customer Service Manager

JOB SUMMARY: Under general supervision, following established procedures, assist and direct members and or providers in an empathetic caring manner, efficiently and timely, and complete appropriate documentation. Respond to member services representatives’ inquiries and attempt to resolve member concerns or refer to management for resolution.

ESSENTIAL JOB FUNCTIONS:

1. Comply with Member Service/Customer Service policies and procedures.

2. Serve as a resource for the call center team by answering questions, providing solutions, and handling member escalations

3. Communicate with members and transportation providers as needed to ensure seamless service delivery experience.

4. Research and resolve all member issues with authorizations, claims, eligibility inquiries and any additional concerns in a timely fashion.

5. Relay critical operational insights and provide feedback to supervisors and managers

6. Maintain professionalism and member confidentiality.

7. Develops an understanding of the grievance and appeals process available to dissatisfied beneficiaries and providers.

8. Adheres to payroll policies and properly uses timekeeping system with minimal manual changes.

9. Maintains regular and consistent attendance.

10. Adheres to Compliance Plan and HIPAA regulations.

MARGINAL JOB FUNCTIONS:

1. Takes on special projects as needed.

2. Performs other duties as assigned.

BEHAVIORAL EXPECTATIONS:

1. Continuous Learning:

a. Attends staff meetings as required.

b. Attends appropriate training, seminars and workshops as required

2. Customer Focus:

a. Maintains client/customer confidentiality and privacy in accordance with HIPPA regulations

and IMAS’s Standards of Conduct.

b. Fosters appropriate communication and relations with Supervisor, co-workers and other staff.

3. Quality/Process Improvement/Safety

a. Reports issues of security, health and/or safety to appropriate supervisor as soon as practicable.

b. Supports and demonstrates safety throughout all duties performed.

c. Follows established policies and procedures and understands and complies with all regulators

standards set forth by governing entities.

POSITION REQUIREMENTS:

EDUCATION/EXPERIENCE:

· High school graduate or equivalent.

· 1 year call center/customer service preferred

SKILLS/KNOWLEDGE/ABILITY:

· Excellent phone etiquette/skills

· Willingness and ability to multitask and problem solve in a fast pace work environment

· Willingness and ability to read, write, speak, understand English and have the communications skills necessary to provide accurate information to residents and staff.

· Willingness and ability to follow written and verbal direction in English.

· Willingness and ability to maintain appropriate level of confidentiality and privacy.

· Willingness and ability to interact professionally with all customers, members, and co-workers, individually and as part of a team.

· Willingness and ability to effectively handle multiple items/tasks as required and adapt favorably to changing priorities.

· Willingness and ability to make appropriate judgments, decisions and problem solving in a timely manner and within the context of the situation at hand.

· Ability to effectively prioritize items/tasks as required.

· Willingness and ability to take initiative and be a self-starter.

· Willingness and ability to understand and comply with Federal, State, and local regulations.

LICENSURE/CERTIFICATE/TRAINING:

· n/a