**Duties & Responsibilities:** + Assist in resolving customer complaints escalated by internal and external business partners as needed. + Assist in reviewing and modifying Physician capitation reports. + Assist in resolving member issues who called in multiple times with the same issues. + Assist in responding and resolving escalated inquiries from other departments and external contacts. + Make recommendations on process improvements. + Build sustainable relationships of trust through open and interactive communication with internal and external customers. + Able to properly follow procedures based on issues and documents received + Make recommendations to management concerning staff performance. + Make recommendations on process improvement. + Maintain open exchange of information with external and internal customers. + Required to multi-task, prioritize and manage time effectively. + Timely filing of complaints. + Conduct outreaches as required. + Attend meetings as business requires. + Additional duties as assigned. **Minimum Qualifications** : + High School Diploma or GED from an accredited institution + Healthcare industry experience + Experience working in customer service + Excellent telephone & customer service skills + Experience working in clerical or administrative capacity + Experience meeting strict deadlines + Proficient in Microsoft suite of applications including Word, Power point, Outlook and Excel. **Preferred Qualifications** : + Associate degree from an accredited school + Conflict Resolution Experience + Experience handling complex situations and/or projects + Experience in developing and coaching of staff Compliance & Regulatory Responsibilities: NA License/Certification: NA WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.