Please attach a cover letter describing why you are a great fit for this role, as well as your resume, when completing your submission for this opportunity.

GENERAL SUMMARY:

Responsible for addressing customer inquiries, grievances (complaints), identify appeals, process Individual plan cancellation requests, process deductible transfer requests while providing problem resolution and education via the HAP Web site (hap.org) Customer Message Center (CMC) and omni channels. Ensure adherence to established time frames to guarantee departmental, organizational and regulatory compliance. Communicate statistical data, trends and opportunities to proactively address member concerns and improve the customer experience.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Provideinvestigation,follow-upandresponseto internal & external customerinquiries received from HAP’s website, email, Pega Workbasket and all other omni channels.
• Work with leadership on escalated complaintstoensuretimelyfollow-up,resolution, compliance andoversight. Include an investigation and analysis of the information and make a recommendation for appropriate course of action toward resolution.
• Generate custom and generic letters to internal and external customers in a prompt and courteous manner for all lines of business per departmental standards and internal/external guidelines. 
• Make outreach phone calls to member to inform of the status of their inquiries and provide telephone support as needed. 
• Respond to all incoming requests within 24 hours with an acknowledgement of receiving their case or aresolution.
• Provide leadership with statistical data to aid in process and performance improvement as it relates to internal and external inquiries. Identify, track and monitor trends and create analysis to ensure all regulatory requirements are met (NCQA, HIPAA, State, CMS etc.)
• Participate in continuous improvement initiatives and present findings.
• Assist in the development of communications to ensure website, email, Pega, and other omnichannel communications are current and reflect relevant brand andcontent.
• Attend meetings as required to gain knowledge of intra-departmental operations and gain knowledge of functional requirements for omnichannel.
• Maintain skills and training knowledge enhancements as needed to performduties.
• Establish and maintain strong relationships and contacts across departments in addition to external contacts to ensure open communication, team effort and positive workrelations.