Senior Complex Customer Care Representative – National Remote Position for Delivering Exceptional Healthcare Navigation and Support Services

Introduction to blithequark

At blithequark, we are driven by a mission to improve the health and wellbeing of individuals and communities. As a global leader in healthcare, we recognize the importance of delivering high-quality, patient-centered care that addresses the unique needs of each individual. Our team is dedicated to making a positive impact on the lives of our members, and we are committed to fostering a culture of diversity, inclusion, and excellence. If you are passionate about healthcare and customer service, we invite you to join our team as a Senior Complex Customer Care Representative – National Remote.

Job Overview

The role of a Senior Complex Customer Care Representative is challenging and rewarding, offering opportunities for individual growth and the development of a variety of skills. As a Senior Complex Customer Care Representative, you will build relationships with individuals and their families, guiding them in navigating and advocating for their benefits, claims, and access to care. You will deliver a best-in-class, consultative member experience across all health and wellbeing carriers, benefits, programs, and plans, creating a more connected experience.

Key Responsibilities

• Build and maintain strong relationships to provide premium level service, removing burdens and providing end-to-end resolution for members
• Answer up to 30 to 60 incoming calls, emails, and chats per day from members of our health, dental, vision, and pharmacy plans
• Contact care providers (doctor’s offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance
• Demonstrate expertise in claims processing and interpretation, resolving any claim-related issues or discrepancies in a timely and efficient manner
• Identify the areas of assistance and offer resolution for benefits, eligibility, claims, financial spending accounts, correspondence, pharmacy, behavioral health, and self-service options
• Educate members about the fundamentals and benefits of managing their health and wellbeing
• Assist in navigating blithequark websites or applications utilizing remote desktop system capabilities
• Construct communication via secure messaging, email, or chat
• Research complex issues across multiple databases and work with support resources to resolve member issues and/or partner with others to resolve escalated issues
• Navigate through multiple platforms and databases to retrieve information regarding medical plans, prescription plans, flexible spending accounts, health reimbursement accounts, vision plans, dental plans, employer-based reward plans, claims submissions, clinical programs, etc.
• Meet the performance goals established for the position in the following areas: effectiveness, efficiency, call quality, member satisfaction, first call resolution, and adherence

Additional Responsibilities

• Performs claims adjustments/dollar payments to providers and/or members ultimately impacting blithequark costs or commercial account costs
• Effectively refer and enroll members to appropriate internal specialists and programs, based on member’s needs and eligibility using multiple databases
• Must remain current on all communicated changes in process and policies/guidelines
• Adapt to all process changes quickly, and maintain knowledge of changes at site level and entity level by utilizing all available resources
• Maximize use of community services, support programs, and resources available to members

Qualifications and Skills

To be successful in this role, you will need to possess a combination of skills, experience, and personal qualities that enable you to deliver exceptional customer service and navigate complex healthcare issues.

Required Qualifications

• High School Diploma/GED or equivalent work experience
• Must be 18 years of age or older
• 2+ years of high-demand contact center and/or customer service experience in a professional environment
• 1+ years of experience within the Healthcare Field, Advocacy Service, Customer Service, and/or Call Center Services, Sales, and Hospitality
• De-escalation experience, including the ability to ensure consumers feel heard and cared for in every interaction
• Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer applications and apply their use while on the phone
• Proficiency with Microsoft Office, including Microsoft Excel, Microsoft Word, Microsoft Outlook, and Microsoft PowerPoint
• Ability to work Monday - Friday, in any of our 8-hour shift schedules during our normal business hours of 8:00 am - 11:00 pm EST, including the flexibility to work occasional overtime and Saturdays, based on the business need

Preferred Qualifications

• Experience with medical or health terminology
• Sales experience, including a demonstrated ability to influence consumer behavior toward highest value outcomes
• Multi-lingual proficiency (e.g., English and Spanish)

Career Growth and Development

At blithequark, we are committed to the growth and development of our employees. As a Senior Complex Customer Care Representative, you will have access to a range of training and development opportunities, including:

• Comprehensive training program to equip you with the skills and knowledge needed to succeed in your role
• Ongoing coaching and feedback to support your growth and development
• Opportunities for career advancement and professional growth within the company
• Access to a range of benefits and incentives, including a competitive salary, bonuses, and rewards

Work Environment and Company Culture

At blithequark, we pride ourselves on our positive and inclusive company culture. As a Senior Complex Customer Care Representative, you will be working in a dynamic and supportive environment that values diversity, equity, and inclusion. Our company culture is built on a set of core values that include:

• A commitment to delivering exceptional customer service and support
• A focus on teamwork and collaboration
• A passion for innovation and continuous improvement
• A dedication to diversity, equity, and inclusion

Compensation and Benefits

As a Senior Complex Customer Care Representative at blithequark, you will be eligible for a range of benefits and incentives, including:

• A competitive salary range of $19.86 to $38.85 per hour
• A comprehensive benefits package, including medical, dental, and vision coverage
• A 401(k) retirement savings plan with company match
• Opportunities for career advancement and professional growth
• A range of incentives and rewards, including bonuses and recognition programs

Conclusion

If you are passionate about delivering exceptional customer service and navigating complex healthcare issues, we invite you to join our team as a Senior Complex Customer Care Representative – National Remote. At blithequark, we are committed to making a positive impact on the lives of our members, and we believe that our employees are our greatest asset. Apply now to join our team and start making a difference in the lives of others.