Escalation specialist job description

Do you want to join a fast-growing organization where you can learn a new craft or build upon your current one? Do you like to have fun and be part of team that cares about you and your success? Then you should consider joining Window Nation!

At Window Nation, we're third-generation window replacement experts who have been lucky to serve communities across the country for over sixteen years. We're proud to be a family-owned business started by two brothers looking to help families improve their most important asset: their home. Since we opened our first showroom in 2006, our company has grown to include 17 showrooms in twenty-one states. We're proud to be the fifth largest window replacement company in the United States - but we're not stopping there. Our company continues to grow each year, and it's all thanks to our team of dedicated, driven employees who make up Window Nation.

When you work at Window Nation, you'll join a team of awesome professionals with hobbies ranging from screenwriting to rock climbing. We're a group of foodies, music enthusiasts, talent scouts, costume makers, pilots, wine makers, community volunteers - oh, and we also sell and install windows, doors, and siding. No matter what you're interested in, you'll find your fit at Window Nation. We don't take your decision to start or further a career with us lightly - and we won't let you down when you do. Don't just take our word, listen to what our employees have to say! Meeting the Window Nation Team!

Reporting to our Escalation Specialist Team Lead, the Escalation Specialist is responsible for receiving, owning, and working toward a resolution on all client and interdepartmental escalations; including, but not limited to, escalated client phone calls, BBB and other Executive complaints, social media reviews, and proactive follow up on outstanding work orders. Utilizing all resources available, the Escalation Specialist ensures a proper resolution while maintaining relationships between departments and ensuring customer satisfaction.
Core Job Responsibilities
Anticipate and swiftly respond to escalated customer issues
Monitor and move forward the facilitation of service orders in all markets
Ensure accuracy of the data entered in our system and assist with reports
Take ownership of any customer situation that is escalated
Perform root cause analysis of escalated scenarios to remedy and enhance procedures
Utilize reporting and logic to determine deficiencies in processes
Leverage PDSA (Plan, Do, Study, Act) models with departments to monitor success
Promote a culture of trust, clarity, and ownership between departments
Basic Qualification
High School Diploma, GED, or equivalent
3+ years of experience focused in direct customer service

Preferred Qualifications
Call center experience is highly preferred
Experience with Salesforce is preferred
Ability to multitask amidst a demanding workload
Maintain a high level of courtesy, empathy, and understanding in every interaction
Commitment to personal and professional standards of excellence
Strong working knowledge of MS Excel
Window Nation cultivates a culture of inclusion that respects our employees' individual strengths, views, and experiences. We believe our differences make us a better team - one that makes good decisions, drives innovation, and delivers better business results.

All qualified applicants will receive consideration for employment without regard to race, color, sex, national origin, religion, age, disability, genetic information, status as a military veteran or any other characteristic protected by applicable law.

You could be the one who changes everything for our 26 million members as a Customer Care professional at Centene. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.

Responds to member, provider, CMS, SPAP and SHIP inquiries received via phone, CTM (Complaint Tracking Module) and email regarding PDP, CCP and Medicaid lines of business, including Claims, CIU, Enrollment, Pharmacy, Billing, Case Management, and Appeals in a professional, timely, accurate and caring manner- while consistently meeting all CMS guidelines and requirements. Instrumental in providing suggestions to reduce complaints and increase WellCare's Star Ratings.
Education/Experience:

High school diploma or equivalent. 1+ years in a Healthcare Contact Center or Customer Service environment handling highly escalated complaints experience. Strong oral, written, and problem solving skills.

· Handle and resolve CTM complaints, SHIP escalated issues, and GCR requests received via HPMS CTM, email, mail correspondence, and inbound/outboundphone calls

· Logs, tracks, resolves and responds to all assigned complaints and inquires in writing and/or by telephone in a timely and professional manner to members, providers, CMS, SPAP/SHIP

· Assist in the education of new members and in the re-education of existing members regarding health plan procedures

· Communicate research and resolution to CMS, SPAP/SHIP representatives, and stakeholders

· Act as a liaison between internal departments and external partners on data gathering and problem solving by investigating and present proposed solutions in a clear and concise manner

· Identify trends, monitor the root cause of member/provider issues, and work cross functionally with all departments to ensure enterprise wide solutions

· Efficiently and effectively, maintain a high caseload while meeting and exceeding all performance standards

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

**TITLE:** Medicare Escalation Specialist I

**LOCATION:** Various, Florida

**REQNUMBER:** 1345054

Eligible applicants must live within the AAA Northeast footprint to be considered for work from home opportunities. This includes RI, MA, CT, NY & NJ. You have applied to a work from home position, and as such, you will be required to meet specific work from home requirements to support the business needs of AAA. This includes high speed internet access with minimum internet speed requirements.

Serves as a member advocate when researching, responding to, or interpreting company procedures or policies with the goal of delighting our valuable members. The nature of these interactions can be highly sensitive and require patience and special handling.
Responsibilities

For bilingual roles, all responsibilities must be able to be completed in both English and target language.

Address formalized complaints from all areas of the Club, encompassing a range of situations that members encounter both from a sales and service aspect.

Meets local and national quality standards for the timely acknowledgement and resolution of complaints.

Determines reimbursements in accordance with established policies.

Maintains accurate logs of workflow, records of member complaints, and station complaint book.

Keeps abreast of new programs, changes in current programs, and/or changes in existing policies and procedures.


Qualifications

Education/Licenses/Certifications:
High School diploma or GED required
Associates degree in Business or related preferred
If for a bilingual job, must satisfactorily pass a translation assessment (from English to the target language and from the target language to English) during pre-hire screening, in accordance with policy - required

Experience:
3 years Customer service experience in a brand focused company required
3 years Handling customer escalations for dissatisfaction with products/services required

Skills & Abilities:
Ability to convince others to buy goods/services or to otherwise change their minds or actions.
Encourage, build, and maintain mutual trust, respect, and cooperation with others
Ability to listen to, understand, and communicate with others by telephone, in written form, electronically, or in person.
Ability to apply sound judgement to produce appropriate outcomes to a variety of situations. Including high volume and challenging situations.
Ability to add, subtract, multiply, or divide quickly and accurately.
Ability to operate a computer with relevant software applications.
Ability to maintain confidentiality.
Ability to act safely.
Ability to prioritize, organize, and accomplish work to achieve specific goals
Developing specific goals and plans to prioritize, organize, and accomplish your work.
If for a bilingual job:
Verbal and written fluency in the stated target language and English.
Ability to facilitate communication between parties who speak two different languages, English and a target language, to effectively and accurately interpret‚ respond. and resolve customer needs and problems.


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