Essential Duties and Responsibilities:
– Interface with and refer complaints and/or inquiries to the appropriate departments, agencies, advocates, and/or client representatives.
– Maintain updated knowledge of managed care as it relates to client supported programs.
– Meet the established processing guidelines, protocols and contract requirements related to complaint processing and the handling of PHI/PII.
– Assist consumers in enrolling, disenrolling, and transferring into health plans, when appropriate.
– Perform other duties as may be assigned by the Complaint Unit Supervisor and/or Project Management.
– Meet all standards established for this position as outlined in the corresponding annual performance criteria and bonus template for this position.
– High school diploma or GED required and 1+ years of relevant professional experience required, or equivalent combination of education and experience.
– Must be fluent in English and specified secondary language.
– Handles more complex customer service inquiries and problems via telephone, recording consistent problem areas.
– May respond to email inquiries.
– Customer service is the primary function.
– Calls are non-routine and require deviation from standard screens, scripts, and procedures.
– Handles situations which may require adaptation of response or extensive research according to customer response.
– Uses computerized system for tracking, information gathering, and/or troubleshooting.
– May handle escalated or unresolved calls from less experienced representatives.
– Works on assignments that are moderately difficult, requiring judgement in resolving issues.
– Understands implications of work and makes recommendations for solutions.
Maximus provides reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment. If you require assistance at any stage of the employment processincluding accessing job postings, completing assessments, or participating in interviews,please contact People Operations at [email protected].
