Participant Experience Specialist

Job Summary:
The Participant Experience Specialist provides excellent telephonic customer service to both participants and providers within a healthcare setting. This role is responsible for addressing inquiries, resolving concerns in a timely and effective manner, and collaborating with other departments as needed to ensure high-quality service. The representative maintains accurate records of interactions, redirects calls appropriately, and ensures all communications are handled with professionalism and care.

Qualifications & Requirements:

• Education: High school diploma or equivalent; Bachelor’s degree preferred.
• Experience: Previous experience in a call center or customer service role, preferably in healthcare or related field. Minimum of one year’s experience working with the frail or elderly.

Duties & Responsibilities:

• Manages incoming calls from participants who may be experiencing pain, illness or are managing other health-related concerns, often seeking assistance with appointments, medications, or care coordination.
• Determines the nature of the incoming telephone calls, channels all incoming calls and routes calls to appropriate departments, as needed.
• Provides courteous and professional customer service via telephone to participants and providers.
• Responds to inquiries and provides information about agency services to participants, families, outside agencies, and the general public, while resolving issues and escalating concerns as needed.
• Collaborates effectively with internal teams and healthcare professionals to ensure a unified, comprehensive, and seamless approach to member support.
• Maintains detailed and accurate records of all calls and interactions while ensuring the confidentiality of company procedures, results, and information related to participants, clients, or families.
• Follows established protocols and procedures to ensure compliance with quality standards, while consistently meeting performance metrics related to call handling, customer satisfaction, and documentation.
• Exercises independent decision-making with minimal oversight, confidently managing responsibilities in alignment with organizational goals, while applying advanced problem-solving skills to navigate complex situations and drive continuous improvement in service quality.
• Manages calls that may involve urgent or time-sensitive healthcare needs, requiring quick thinking and effective communication, as well as calls from providers requesting information, clarification on procedures, or coordination of services.
• Performs other duties as required or requested.