Alta Resources is Hiring!

SUMMARY

The role of Licensed Healthcare Customer Care Representative is to deliver superior support for customer service experiences to consumers. In doing so, he or she ensures that all consumer interactions are documented with high reliability and quality. The Licensed Healthcare Customer Care Representative also provides management support in the areas of quality assurance and training along with full documentation review on all medical claims from consumers or client departments.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

Ensure 100% of all Adverse Events and other critical consumer interactions are reviewed and assessed on quality of information captured in a designated database on a daily basis.

Complete requested follow-up action on consumer interactions.

Identify and document serious contacts as defined in SOPs. Escalate to management as appropriate.

Provide support for Advisors as needed.

Provide reconciliation and quality oversight of consumer interactions.

Establish and maintain a high-level of product knowledge.

Establish and maintain strong competencies with all computer systems and processes involved in the handling of consumer interactions.

Review consumer-reported adverse events, product complaints, and consumer questions and comments via all channels the business supports.

Build rapport and loyalty with consumers through exceptional verbal and written interactions. Be compassionate and skillful in ensuring caller’s needs and expectations are met and exceeded.

Formulate and ask probative questions to effectively elicit information required in product safety and quality assessments as well as regulatory reporting while taking care not to influence or introduce bias into the caller’s description of the event.

Handle sensitive and private information in accordance with regulatory requirements and follow applicable Standard Operating Procedures (SOP) and Work Instructions (WI).

Report identified Consumer Care Center training needs and system errors/discrepancies to the Team Lead.

Achieve and maintain category and client metrics.

Complete other tasks as deemed appropriate by leadership.

Receive medical claims from consumer and/or the client and review for requests regarding reimbursement.

Monitor call flow and queue activity as required.

Identify process improvement opportunities and recommend solutions.

Escalate critical issues to designated management representatives.

Handle and protect individually-identifiable health information in accordance with HIPAA and similar security/privacy regulations and standards.

This position will not provide medical advice or counsel to consumers.

LEADERSHIP RESPONSIBILITIES

There are no direct-reports associated, but expected to lead-by-example.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Proven experience with varied technology systems including reporting is required.

Experience providing, managing, and training world-class customer care via multiple communication channels is preferred.

Excellent business communication skills required along with organizational skills, attention to detail, and a positive and professional demeanor.

Able to foster remarkable consumer experiences with strong interpersonal and conversational skills. Excellent verbal and written communicator.

Able to comfortably respond to consumers’ questions and concerns.

Able to display patience and empathy while ensuring consumer needs are fulfilled in a timely and satisfactory fashion.

Must demonstrate good listening skills, problem solving, and decision-making abilities.

Exercises good judgment. Knows when to involve supervisors.

Must follow all applicable compliance regulations to properly handle the consumer interaction and personal, individually-identifiable information.

Must accurately document all interactions using appropriate terminology.

Have strong attention to detail and accuracy.

Strong organizational skills and communication skills, both written and verbal.

Must have the proven ability to meet deadlines in a fast-paced environment.

Ability to function in a team environment and embrace change.

Must have the proven ability to work independently and deliver results.

Highly self-motivated and directed with the ability to prioritize and execute tasks.

High-level understanding of FDA regulations.

Complete all required training by deadlines.

Demonstrate applied competency in quality/compliance standards and applicable Program, Client and Corporate policies, procedures and work instructions though appropriate and timely analysis, decision-making, communication and recordkeeping.

Successfully complete all Certification program(s) that apply to assigned role(s).

Maintain health care professional licensure/registration with State of Wisconsin as current and in good standing.

EDUCATION and/or EXPERIENCE

Bachelor’s degree from four-year college or university preferred.

Professional licensure as Registered Nurse or Licensed Practical Nurse with clinical experience required. Health care professional credentials in good standing.

TECHNOLOGY SKILL BASE

This position requires a working knowledge of computer technology that includes Microsoft Office Suite. Individuals must possess the ability to learn and understand new software and other technology applications as introduced by the Client and Alta Resources.

LANGUAGE SKILLS

Ability to read and comprehend complex instructions. Ability to communicate in an effective manner, both orally and written.

MATHEMATICAL SKILLS

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions and decimals.

REASONING ABILITY

Ability to apply common-sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.

PHYSICAL DEMANDS

While performing the duties of this job, the employee is regularly required to sit for up to eight hours, and stand. Manual dexterity which allows the individual to use hands to type on a keyboard, use a mouse and write are required, as is the ability to talk and hear. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The environment for which this position functions contains scents and fragrances related to product samples that are necessary to have on site in order to complete the essential job functions of this position or others positions within the same area. Due to the nature of this work, individuals are required to be on-site during hours designated by the Client; however, the occasion will arise when the employee must be off-site due to business functions.