Why This Role is Important to Us:

　　The Contact Center Research Specialist is responsible for providing accurate, prompt, and courteous resolution to unresolved inquiries. This position facilitates quality member and provider service delivery by responding to every inquiry immediately and directly, when possible, or by collaborating and escalating to the various CCA teams, when necessary.

　　The Contact Center Research Specialist is responsible for resolving escalated issues by providing in depth research of various sources of data to rectify member and provider issues. This role must ensure thorough documentation of all issues while maintaining department records in the appropriate systems of record in accordance with CCA policies, CMS compliance requirements and state regulations.

　　This role will establish and maintain a professional relationship with internal and external CCA customers, team members and department contacts, and utilize organizational skills to maintain timely and accurate progression of aging inventory.

　　Supervision Exercised: No

　　What You'll Be Doing:

　　Collaborates with CCA internal and external clients virtually, to determine their research needs and provide a comprehensive resolution to open issues.

　　Exercises independence to attend to research requests efficiently and timely.

　　Accesses and extracts data from a variety of primary and secondary sources and in a variety of formats as part of the resolution process

　　Thoroughly researches websites, health plan sites, portals, internal reference material, third-party vendor data systems and custom tools to identify accuracy of information and identify root causes of issues.

　　Reports findings through the explanation of data and provides expert SME guidance to leadership and others.

　　Explores and innovates new methods and technologies for information retrieval, synthesis, and analysis and proposes techniques to improve research quality and team productivity.

　　Utilizes established standard operating procedures and collaborates with internal CCA departments and key stakeholders such as: Care partners, Utilization Management, Claims and Ancillary Services, to provide prompt resolution to member's unsolved requests.

　　Assists CC management with CCA systems reports and data corrections.

　　Responsible for timely and effectively processing of an aging inventory of member and provider requests.

　　Accesses and understands all related benefit coverage resources, tools, and materials to respond to a member's inquiries and concerns correctly.

　　Participate as part of a team conducting and/or supporting outreach to members regarding benefits and eligibility requirements.

　　Thoroughly logs all member related and provider interactions into CCA databases for purpose of accurate tracking and analysis.

　　Troubleshoots escalated claims issues from Provider Services Reps

　　Research in PBM and outreach Network Pharmacies to intervene/resolve pharmacy authorization/claims Issues.

　　Conducts additional research, including call review, to ensure all complaint intakes are robust and ready for investigation.

　　Performs follow up calls for dental, pharmacy, and other benefit inquiries that were not a one call resolution, including processing pharmacy overrides and rejections for members.

　　Conducts telephonic outreach to member, providers, CCA ancillary vendors or pertinent state agencies, when necessary for issue resolution.

　　Assists with member mailings and responds to questions about mailings.

　　Processes complex requests including disenrollment and reimbursements.

　　This role is responsible for other duties as assigned by CC Leadership.

　　Is able to perform the essential duties of the position with or without reasonable accommodation.

　　Working Conditions:

　　Standard office conditions.What We're Looking For:

　　Education Required:

　　Associate degree or relevant work experienceOr

　　Accreditation from a technical school in relevant course of workExperience Required:

　　1 -- 3 years

　　Experienced working and prioritizing an assigned work queue of aging inventory.

　　Excellent interpersonal and written and verbal communication skills.

　　Experience Desired:

　　3 yrs. + Relevant work experience in the health care industryKnowledge, Skills & Abilities Required:

　　Strong oral and written communication skills

　　Excellent organizational skills with the ability to prioritize tasks effectively.

　　Must have experience working in a diverse environment: colleagues, members and providers are diverse socioeconomically, ethnically, and culturally.

　　Must possess exceptional Microsoft Office Skills (Word, Excel, Outlook, Power Point), and Internet research skills.

　　Must have one year or more experience providing customer-focused service/activities; experience researching multiple type of member and provider inquires in the health care sector at one time.

　　Must be experienced in managing copious amounts of request received through multiple channels; experience independently problem-solving by referencing information and policies.

　　Knowledge, Skills & Abilities Desired:

　　Experienced In CRM preferred.

　　Knowledge of research principles, concepts, practices, and methods.

　　Language(s) Required:

　　EnglishLanguage(s) Desired:

　　Bilingual in Spanish, Portuguese, or Haitian CreoleEEO is The Law

　　Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

　　Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.