Contact Center Specialist

Contact Center Specialist

Fully Remote

About SCAN
SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation’s leading not-for-profit Medicare Advantage plans, serving more than 270,000 members in California, Arizona, and Nevada. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided with in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter.

The job
The customer experience specialist is a generalist role that has skills, training, and expertise in both member and provider service. The position will cover a variety of responsibilities, including escalation, research, operational improvement, coaching, and serving as a subject-matter expert.

You will

• Handle escalated member issues, escalated provider issues – including claims escalations -- and delegated projects that require research and interface with other functional areas, business partners, or company leadership for intervention and resolution.
• Handle complex issues where additional information, clarification, and problem solving is needed to resolve questions, disputes and/or obtain further information.
• Identify and escalate appropriate issues in a timely manner. This includes any call problems, provider/contractual issues, computer system issues, and/or operational issues.
• Conduct quality assessments of customer experience to ensure they are handled to company/department standards and customer expectations. Monitoring, assessing, and improving performance of outsourced call center. Identify areas for improvement, provide coaching, and propose appropriate course of action for learning/coaching/training.
• Lead and assign service recovery and special escalation efforts and identify opportunities to improve outcomes for specific member inquiries and escalations, including case review from multiple member-facing programs, including voice of customer, pay and educate, among others. Making outbound calls to members and providers as part of the service recovery and special escalations.
• Assist management with data collection and research pursuant to routine or specially escalated requests from regulatory oversight entities, company compliance departments, and company leadership.
• Assist management with training and development of Member Services and Provider Services teams; provide operational and agent feedback to outsourced provider services contact center.
• Works with the Claims Auditing Unit to assure that incoming calls are handled in an accurate, timely, and courteous manner. Identifies areas for improvement, provides coaching, and proposes appropriate training.
• May provide feedback to management team regarding advocates’ performance as it relates to established standards.
• Maintain familiarity with system reports, standard reference manuals, standard coding and system codes.
• Maintains knowledge of on-line claim system and SCAN Policies and Procedures including benefit plans, Divisions of Financial Responsibility (DOFR), and contracts.
• Participate in process improvement, system implementation and ongoing support. Act as the benefit Subject Matter Expert for SCAN Health Plan, by possessing deep knowledge and specialized skill set pertaining to Member benefits, provider service processes, and SCAN’s policies and procedures.
• Under supervision of the management team, may oversee uniform maintenance of all current Desktop Procedures and reference materials for the unit.
• Responsible for fostering positive relationships with internal constituents and departments by working cross-functionally and collaboratively to resolve member issues. Seek to build trust, respect and credibility with all partners through full, honest, consistent, and coordinated communication.
• Provide back-up support for the Contact Center by answering incoming member and provider calls as needed.
• Follow all appropriate Federal and State regulatory requirements and guidelines applicable to SCAN Health Plan operations, as documented in company policies and procedures. Follow all HIPAA requirements.
• Actively support the achievement of SCAN’s Vision and Goals.
• Other duties as assigned.

Your qualifications
• Required: G.E.D. / High School
• 4+ years' work experience in a highly matrixed Customer Service environment.
• Ability to deal with ambiguity, while working cross-functionally and collaboratively across the organization.
• Ability to research, analyze and resolve member issues independently, while demonstrating compassion and responsiveness.
• Ability to effectively present information and respond to questions from members, downstream providers, peers and management.
• Ability to speak using clear and professional language and answer telephone using appropriate etiquette.
• Ability to lead teammates through influence, knowledge, and persuasion.
• Ability to provide constructive feedback to teammates.
• Ability to work in a fast paced environment with changing priorities, while maintaining a calm demeanor.
• Technologically savvy and able to utilize information systems effectively.
• Strong interpersonal skills, including excellent written and verbal communication skills.
• Strong organizational skills; Ability to multitask.
• Ability to appropriately maintain confidentiality.
• Strong analytical and critical thinking skills, required.
• Prior customer service training, required.

What's in it for you?

• Base Pay Range: $23.50 to $37.59
• Work Mode: Mostly Remote
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)- 11 paid holidays per year, 1 floating holiday, birthday off, and 2 volunteer days
• Excellent 401(k) Retirement Saving Plan with employer match
• Robust employee recognition program
• Tuition reimbursement
• An opportunity to become part of a team that makes a difference to our members and our community every day!

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.
SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required. #LI-JR1