Escalation Response Specialist IV

Escalation Response Specialist IV

Requirements

• High School diploma or GED
• 4+ years of related experience
• Vocational or technical education may be required
• Experience as a Supervisor or Lead role is highly preferred
• Familiarity with Medicaid, Medicare, HBX, and Managed Long Term Care (MLTC) is preferred

Responsibilities

• Responds to non-routine and/or complex complaints and escalations from members or providers
• Handles escalations, handling problem tickets, and providing feedback to upper management regarding member and/or provider issues
• Provides timely and appropriate resolutions to escalated issues received from various communication channels
• Serves as a liaison in maintaining relationships between departments to ensure timely and appropriate issue resolution
• Documents, tracks, resolves, and responds to all assigned complaints and inquiries in writing and/or by telephone in a timely and professional manner
• Conducts and monitors root cause of member or provider issues to identify trends across the enterprise
• Acts as a primary contact for escalated calls and/or issues in which special care is required
• Develops and leads projects and initiatives within the escalation response team to support process improvements
• Leads efforts with contact center team to research, review underlying facts of escalated inquiry, and determine validity of complaints
• Provides timely status update reports to members and internal stakeholders to support transparency and improve the customer experience
• Maintains up-to-date knowledge of our products and services to provide accurate and effective support to customers
• Performs other duties as assigned
• Complies with all policies and standards

Preferred Qualifications

• Experience as a Supervisor or Lead role is highly preferred
• Familiarity with Medicaid, Medicare, HBX, and Managed Long Term Care (MLTC) is preferred