Sr. Escalation Coordinator

  • location: Tampa, FL
  • type: Contract
  • salary: $25 per hour
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job description

Sr. Escalation Coordinator

job summary:
GENERAL JOB INFORMATION

Sr. Escalation Coordinator

JOB SUMMARY

Research and resolve all escalations from members/providers that have been addressed to Company's Executive Offices, Executive Leadership Team or the CEO (Presidential) as well as complaints coming from other escalated areas such as MET, Grievances, and other areas for final resolution. The Service Escalation Unit (SEU) team is the highest level of escalation and handles issues for all lines of business (Medicare, Medicaid, PDP & Exchange).

ESSENTIAL FUNCTIONS

Note: The following is not intended to be an exhaustive list of all duties required of this position

Key Duties and Responsibilities

- Resolve the most highly escalated issues coming from other escalated areas such as MET, Grievances, and other areas for final resolution. The SEU team is the highest level of escalation.

- Take escalated inbound/outbound phone calls on behalf of our Executive Leadership Team for all lines of business while maintaining the highest standard of quality on every call. (Calls are monitored for Quality and Training purposes.)

- Logs, tracks, resolves and responds to all assigned inquires and complaints from members, providers, governing bodies, Regulatory Agencies, Better Business Bureau, Social Media, Company Legal Department, Corporate Compliance TRUST Department, Agency for Healthcare Administration (AHCA) and Florida Healthy Kids in writing and/or by telephone, while meeting all regulatory, AHCA and Company Corporate guidelines in which special care is required to enhance Company's relationships; while meeting and exceeding all performance standards.

- Subject Matter Expert in all lines of business.

- Effectively handle/resolve highly escalated issues and represent our CEO in responding to these complaints in a professional manner seeking a win/win for all parties while respecting sound business and health management practices.

- Assist in the education of new members and in the re-education of existing members regarding health plan procedures.

- Thoroughly research and effectively communicate with our members regarding the resolution of their inquiries, complaints and issues with a professional demeanor in a clear, articulate, and timely manner while demonstrating a strong understanding of the issues.

- Work with providers to correct billing and claim issues and educate providers about how to eliminate those problems going forward.

- Act as a liaison between internal departments and external partners on data gathering and problem solving while investigating problems of an unusual nature in the area of responsibility. Present proposed solutions in a clear and concise manner.

- Identify trends and monitor the root cause of member/provider issues and work cross functionally with different departments to ensure enterprise wide solutions.

- Perform other duties as assigned.

Additional Position Responsibilities - Optional

MINIMUM QUALIFICATIONS

Education

State the minimum required for the job

Education Level Education Details Required/Preferred

A High School or GED Required

Other Associate's or Bachelor's degree in related field Preferred

Work Experience

State the minimum required for the job

Experience Level Experience Details Required/Preferred

3+ years of experience in a healthcare Contact Center or Customer Service environment handling escalated complaints involving one or more of the following Lines of Business: Medicare, Medicaid, PDP, Exchange, etc. Required

Licenses and Certifications

List professional licenses and certifications associated with this job

Licenses/Certifications Other Licenses/Certifications Required/Preferred

Other Customer service, quality, or training certifications Preferred

Skills

State the minimum required for the job


Skill Sets Other Skills Proficiency

Demonstrated written communication skills Advanced

Demonstrated interpersonal/verbal communication skills Advanced

Ability to multi-task Advanced

Demonstrated organizational skills Advanced

Demonstrated time management and priority setting skills Advanced

Ability to effectively present information and respond to questions from families, members, and providers Advanced

Demonstrated analytical skills Advanced

Other Ability to work with people from diverse backgrounds Advanced

Other Ability to act on feedback provided by showing ownership of his or her own development Advanced

Other Ability to define problems collects data, establish facts and draw valid conclusions Advanced

Other Seeks to build trust, respect and credibility with all partners through full, honest, consistent, and coordinated communication Advanced

Technology

List technical skills associated with the job


Technology Other Technology Proficiency Required/Preferred

Microsoft Outlook Intermediate Required

Microsoft Word Intermediate Required

Microsoft Excel Intermediate Required

Microsoft PowerPoint Intermediate Preferred

SharePoint Intermediate Preferred

Languages

List all that apply

Languages Other Languages Required/Preferred

Spanish Preferred

 
location: Tampa, Florida
job type: Contract
work hours: 8 to 5
education: Bachelor's degree
experience: 3 Years
 
responsibilities:
Key Duties and Responsibilities

- Resolve the most highly escalated issues coming from other escalated areas such as MET, Grievances, and other areas for final resolution. The SEU team is the highest level of escalation.

- Take escalated inbound/outbound phone calls on behalf of our Executive Leadership Team for all lines of business while maintaining the highest standard of quality on every call. (Calls are monitored for Quality and Training purposes.)

- Logs, tracks, resolves and responds to all assigned inquires and complaints from members, providers, governing bodies, Regulatory Agencies, Better Business Bureau, Social Media, Company Legal Department, Corporate Compliance TRUST Department, Agency for Healthcare Administration (AHCA) and Florida Healthy Kids in writing and/or by telephone, while meeting all regulatory, AHCA and Company Corporate guidelines in which special care is required to enhance Company's relationships; while meeting and exceeding all performance standards.

- Subject Matter Expert in all lines of business.

- Effectively handle/resolve highly escalated issues and represent our CEO in responding to these complaints in a professional manner seeking a win/win for all parties while respecting sound business and health management practices.

- Assist in the education of new members and in the re-education of existing members regarding health plan procedures.

- Thoroughly research and effectively communicate with our members regarding the resolution of their inquiries, complaints and issues with a professional demeanor in a clear, articulate, and timely manner while demonstrating a strong understanding of the issues.

- Work with providers to correct billing and claim issues and educate providers about how to eliminate those problems going forward.

- Act as a liaison between internal departments and external partners on data gathering and problem solving while investigating problems of an unusual nature in the area of responsibility. Present proposed solutions in a clear and concise manner.

- Identify trends and monitor the root cause of member/provider issues and work cross functionally with different departments to ensure enterprise wide solutions.

- Perform other duties as assigned.

Additional Position Responsibilities - Optional

 
qualifications:
MINIMUM QUALIFICATIONS

Education

State the minimum required for the job

Education Level Education Details Required/Preferred

A High School or GED Required

Other Associate's or Bachelor's degree in related field Preferred

Work Experience

State the minimum required for the job

Experience Level Experience Details Required/Preferred

3+ years of experience in a healthcare Contact Center or Customer Service environment handling escalated complaints involving one or more of the following Lines of Business: Medicare, Medicaid, PDP, Exchange, etc. Required

Licenses and Certifications

List professional licenses and certifications associated with this job

Licenses/Certifications Other Licenses/Certifications Required/Preferred

Other Customer service, quality, or training certifications Preferred

Skills

State the minimum required for the job


Skill Sets Other Skills Proficiency

Demonstrated written communication skills Advanced

Demonstrated interpersonal/verbal communication skills Advanced

Ability to multi-task Advanced

Demonstrated organizational skills Advanced

Demonstrated time management and priority setting skills Advanced

Ability to effectively present information and respond to questions from families, members, and providers Advanced

Demonstrated analytical skills Advanced

Other Ability to work with people from diverse backgrounds Advanced

Other Ability to act on feedback provided by showing ownership of his or her own development Advanced

Other Ability to define problems collects data, establish facts and draw valid conclusions Advanced

Other Seeks to build trust, respect and credibility with all partners through full, honest, consistent, and coordinated communication Advanced

Technology

List technical skills associated with the job


Technology Other Technology Proficiency Required/Preferred

Microsoft Outlook Intermediate Required

Microsoft Word Intermediate Required

Microsoft Excel Intermediate Required

Microsoft PowerPoint Intermediate Preferred

SharePoint Intermediate Preferred

 
skills: Other
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

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