Customer Service Specialist

About This Role

This role involves handling escalated calls from members, providers, or vendors to resolve issues, educating members on available benefits, and intervening with care providers for appointment scheduling or specialist connections within the Liberty Advantage program.

Responsibilities

• Handle escalated calls from members/providers or vendors, resolving issues preferably on the first contact
• Educate members on available benefits, including resolving claim information and setting up enhanced benefits
• Intervene with care providers on behalf of customers to assist with appointment scheduling or connections with internal specialists
• Assist the enrollment team in setting up new members
• Document and resolve Appeals and Grievances within CMS-required time frames
• Research complex issues across multiple databases and collaborate with support resources to resolve customer issues or escalated issues
• Set up and triage prior authorization requests, working through clinical protocols

Requirements

• High School Diploma/GED or equivalent work experience
• 3+ years of combined education, work, and/or volunteer experience
• Excellent listening, verbal, written, and interpersonal communication skills
• High level of professionalism and confidentiality
• Strong customer service focus
• Adaptability to operational needs with excellent follow-up skills
• Self-motivated with dedication and discipline to work independently
• Valid driver’s license
• Ability to communicate concisely and confidently with all staff levels and clearly communicate instructions to remote users

Qualifications

• High School Diploma/GED (or higher) OR equivalent work experience
• Minimum of 3+ years of combined education, work and/or volunteer experience

Nice to Have

• Experience in Health Care Customer Service