Customer Experience Team Lead

Position Summary: Addresses escalated member inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care. Responsible for receiving, responding to, and directing calls from the ACD phone system. May run reports from the ACD call center system when required. Provides available information upon request and escalates issues as appropriate. Maintains confidentiality per HIPAA guidelines.

Essential Duties and Responsibilities:

• Addresses escalated member inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care.
• Trains, coaches and motivates team members in all aspects of call center service handling to include metrics, real-time performance feedback, behavior related to customer experience.
• Creates and maintains training manual updated.
• Responsibility for training of new Member Services Representative and conducts update training section to all department.
• Conducts regular review of all call center agents' performance and organize training sessions to respond to training and performance needs.
• Schedules and organizes shift patterns for other team members to ensure that call center has adequate coverage.
• Receives and directs calls from the ACD phone system to accessible resources.
• Acts as the initial information source and answers questions, assigns tasks, follows up and gives instructions as needed.
• Ability to manage urgent calls in such a way that urgent situations related to the provision of patient care are handled in an appropriate and prompt manner.
• Ensures client satisfaction by providing prompt response and solutions to queries.
• Prepares reports and supporting documentation as needed for review by Supervisor and Director of the Member Services Department.
• Identifies and communicates calls/inquiries that require escalation calls to Call Center Supervisor and/or Director.
• Ensures a safe and harmonious working environment for all other team members.

This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management.

Qualifications:

• Minimum High School or GED Diploma.
• Associate or bachelor's degree preferred
• Two (2) years HMO Health Care Plan Experience.
• Familiar with a variety of the Call Center's concepts, practices, and procedures.

Skills and Abilities:

• Ability to maintain composure under pressure
• Excellent customer service and team management skills
• Outgoing energetic attitude
• Excellent listening skills
• Ability to multitask and problem solve in a fast-paced environment
• Leads and directs the work of others.

Work Schedule:

Community Care Plan is currently following a hybrid work schedule. The company reserves the right to change the work schedules based on the company needs.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear. The employee is frequently required to stand, walk, and sit. The employee is occasionally required to stoop, kneel, crouch or crawl. The employee may occasionally lift and/or move up to 15 pounds.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic, travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating and preserving a culture of diversity, equity and inclusion.

Background Screening Notice:

In compliance with Florida law, candidates selected for this position must complete a Level 2 background screening through the Florida Care Provider Background Screening Clearinghouse.

The Clearinghouse is a statewide system managed by the Agency for Health Care Administration (AHCA) and is designed to help protect children, seniors, and other vulnerable populations while streamlining the screening process for employers and applicants.

Additional information is available at:

hhttps://info.flclearinghouse.com