Serves as a liaison, advocate and subject matter expert for an assigned client. First contact for the client and coordinates resolution of complex non-routine issues such as adverse benefit determinations, complex claims or ITS related inquires. Reviews reports and identifies trends in issues impacting client satisfaction. Analyzes, develops and implements service center workflow and procedure changes. Provides supplemental and on-the-job training to new and existing Service Representatives/Health Guides in individual or group settings.

Serves as primary resource for service staff in interpretation of contracts, benefits, systems, procedures or policies. Serves as a liaison between customer service and other areas of the company to bring resolution to service issues.Identifies trends in Service Representative questions and makes recommendations to supervisor regarding training, coaching and development opportunities. In the absence of the supervisor, determines appropriate allocation of resources for phone coverage and written correspondence. Analyses, develops and implements workflow and procedure changes. Provides supplemental and on-the-job training to new and existing Service Representatives in individual or group settings.

Responds to customer telephone inquiries or written inquiries within a call center environment.Corresponds with internal and external customers in writing.Serves as a customer advocate by identifying underlying customer needs and guiding them to appropriate resources or programs.Provides information to members to support them in their healthcare decisions.Researches and responds to inquiries to ensure timely resolution of issues. Builds customer rapport by offering information and services beyond the customer’s initial inquiry.Identifies system, coding, and procedural problems and alerts the appropriate individuals regarding the discrepancies.