Customer Care Specialist I – Member Services

CareSource - Full Time

Job #20564


  • Assist members with routine service inquires including but not limited to; selecting a primary care physician, member benefit education, member identification cards, transportation arrangements, issues with provider accessibility, eligibility inquires, resolving member complaints, identifying and filing member grievances
  • Provide quality service by immediately responding to the member and/or providers requests and complaints, and appropriately routing issues to the correct department for timely resolution
  • Assist members with processing their premium payments
  • Assist a provider with routine service inquires including but not limited to; verifying eligibility, explanation of benefits, claims and appeal procedures
  • Capture member grievance, and relay appeals instructions for the appropriate line of business, including future lines of business
  • Ensure all HIPAA and State requirements/regulations are adhered to at all times, in existing and future lines of business
  • Research, follow up, and resolve all open/pending issues in a timely manner to ensure member satisfaction
  • Build and strengthen member relationships by providing quality customer service
  • Maintain knowledge and understanding of all processes and procedures
  • Adhere to all departmental and company policies and procedures
  • Maintain complete and accurate documentation of all of telephone and written communications
  • Act as a mentor to new hire employees
  • Screen members to determine Case Management needs, and refer when appropriate
  • Appropriately route calls to support departments including Pharmacy, and Triage, for proper/expedited resolution
  • Assist with non-phone work such as incoming faxes and web inquires


Education / Experience:
  • High School Diploma or equivalent is required
  • Two (2) years customer service experience is preferred
  • Customer Service experience in a call center is preferred
Required Competencies / Knowledge / Skills:
  • Computer proficiency with knowledge and experience in a “Windows” environment
  • Typing speed of 35 words per minute (WPM)
  • Strong written and communication skills
  • Professional phone etiquette
  • Proper use of grammar
  • Ability to work in a fast paced environment
  • Adaptable to a constantly changing environment
  • Attention to detail
  • Ability to multitask
  • Ability to work independently and with a team
  • Critical thinking and listening skills
  • Decision making and problem solving skills


Customer Service