The Inbound Contacts Representative 2 represents the company by addressing incoming telephone, digital, or written inquiries. The Inbound Contacts Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.
The Inbound Contacts Representative 2 serves as a member advocate, addressing customer needs, which may include acting upon complex benefit needs, resolving grievances, and educating members. The ICR 2 documents member inquiries and resolutions provided per Centers for Medicare and Medicaid compliance criteria. The ICR 2 role intakes calls, makes outbound calls, resolves grievances and follows the escalation protocol when necessary to address member needs. ICR 2 role must adhere to the member services department protocols that speak to plan benefits as well as align to CMS mandates in the handling of organization/coverage determinations, grievances and appeals. This role is a highly structured role requiring continuous referencing of policies and protocols. Active listening and the intention to work in a proactive manner is key to success in the role. Role does require ongoing receptiveness to training and performance feedback, as compliance mandates are continuously updating and we are audited against our adherence to these.
Work Environment: This is a customer-centric member advocate environment focused on high quality outcomes versus activities. Our department primarily communicates over the phone, but we are not a “call center” environment as we are responsible for the member’s safety and advocacy outcome as part of the continuum of their care. We value quality work as every action taken in the member services department is to facilitate access to the member and avoid adverse outcomes for the member.
- Associates can expect to take anywhere from 25 to 35 inbound calls per day with the focus being on high-quality service with a strong emphasis on member advocacy and patient safety.
- While this associate receives inbound calls, up to 60% to 70% of these calls may require associates to place outbound calls to physicians, DME vendors, pharmacies or other entities to coordinate benefits and care for the member.
- This role calls for strong emotional intelligence focused on proactively providing solutions, ensuring the member’s utmost health and safety. De-escalation skills are a must to thrive in this role. We serve a wide variety of members, some of which are experiencing illness and trauma at the time of their call.