The Service Delivery Consultant is responsible for increasing customer satisfaction and retention by providing members, customers, patients and providers with accurate, consistent, timely and meaningful information. They will provide support to members’ inquiries and issues as they utilize the client’s plan and provider services, continuing to build rapport and collaborative relationships with current and prospective members in accordance with compliance guidelines.

Essential Responsibilities:

Available to handle member inquiries regarding:

Member Services: Facility Inquiry, Web Support, Order ID Card, Complaint, ID Card Inquiry, Service Review, Eligibility Inquiry, Benefit Inquiry, General, Complaint, Correspondence Inquiry, Add/Remove Dependent, Service Review, New Member Experience, Internal Regional Request, IVR Defaults.

Medicare

Billing: Billing Inquiry, Make Payment, Complaint, EFT Inquiry, General, Reinstatement Request, Service Review, 1095 Tax Form.

Represents Health Plan by answering and documenting all incoming contacts to determine their nature and to respond to complex calls related to specialized product lines or queues.

Responds professionally to inquiries from internal/external customers. Promotes, ensures and provides customer service to internal/external customers by demonstrating skills which are consistent with the organization’s philosophy of providing extraordinary customer relations and quality service.

Initiates contact with the appropriate Health Plan, medical group and facility personnel to obtain information relevant to the concern or inquiry as needed.

Evaluates data to determine and implement the appropriate course of action to resolve the complaint and/or coordinate service recovery.

Documents conversations with members according to the procedure.

Follows established procedures to meet customer/member needs.

Has a substantial understanding of the assigned skills and applies knowledge and skills to complete a wide range of tasks.

Ability to understand relevant policies, processes and customers.

Assist the department in meeting customer needs and reaching department expectations.

Completes required training and understand how to use tools available to recall necessary information.

Develop a full awareness of the way performance and actions affect members and Member Service.

Maintains Contact Center performance KPIs for call handling, first call resolution, complaint resolution compliance, member retention, and return contact as warranted.

Consistently supports compliance and the Code of Conduct by maintaining the privacy and confidentiality of information, and protecting the assets of the organization.

Preferred Qualifications:

· Call center experience preferred.

· Health insurance experience preferred

Basic Qualifications:

Experience

· Minimum two (2) years of customer service experience or healthcare member-interacting experience required

· High School Diploma or General Education Development (GED) required.

Additional Requirements:

· Excellent written and verbal communication skills.

· Demonstrated analytical and problem-solving skills.

· Ability to read and respond briefly, clearly and effectively.

· Ability to think critically and problem-solve.

· Typing test - 30 wpm with a 5% or less error rate

· Must successfully pass knowledge checks while in training.

Apply Now

SPANISH BILINGUAL SERVICE DELIVERY CONSULTANT - REMOTE

VXI Global Solutions