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Southwestern Health Resources CIN - Pittston, PA
posted 4 months ago
About the position
The Customer Experience Specialist I at Care N' Care Health Plan is responsible for providing exceptional customer service and support to members, ensuring a positive experience with the health plan. This role involves handling customer inquiries, resolving issues, and assisting with various health plan services. The position is hybrid, requiring occasional onsite attendance for meetings and training, and is part of a larger clinically integrated network focused on patient-centered care.
Responsibilities
- Provide exceptional customer service to members and potential members of the health plan.
- Handle inquiries and resolve issues related to Medicare and Medicare Advantage plans.
- Assist with enrollment and eligibility questions for health plan services.
- Maintain thorough knowledge of CMS guidelines and processes to ensure compliance.
- Participate in department meetings and training sessions as required.
- Work on special projects independently or as part of a team.
Requirements
- High School Diploma or Equivalent required; Bachelor's Degree preferred.
- 2 years of customer service, sales, or account management experience in Medicare or applicable health plan experience preferred.
- 2 years of experience in multi-functional high volume customer interaction preferred.
- Thorough knowledge of CMS guidelines, processes, and systems.
- Excellent problem-solving and organizational skills.
- Strong interpersonal communication skills, both oral and written.
- Ability to multitask and learn quickly in a fast-paced environment.
- Proficient in Microsoft Office suite of products.
Nice-to-haves
- Experience with PPOs and HMOs, Employer Group, and Commercial insurance.
