• Performs as the advocate that focuses on resolving complex issues or concerns for members or providers. • Leverages a variety of communication channels to provide members or providers with timely, accurate, and personalized resolutions on complex complaints and escalations. • Assesses and researches customer service needs, determines causes, and initiates corrective actions to other service or technical departments for follow up as needed. • Provides guidance on various complex member or provider issues to resolve customer’s inquiries or requests. • Provides member or providers with information and resources to further educate relevancy to the complex inquiry or concern. • Provides customer service in a high pace contact center environment over the phone, via live chats and emails. • Continues to develop in-depth knowledge and deep expertise in multiple additional markets and/or plans in multiple subject areas and responds to complex or escalated questions. • May lead the team in member or provider request resolution and collaborates inter-departmentally to resolve inquiries or concerns. • Identifies, documents and resolves all customer information and communications and updates leadership on customer needs thru root cause analysis, recommendation and resolution. • Collaborates with training teams to develop training materials and/or programs to ensure quality and adherences to policies and procedures. • Records all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application, including customer interactions, details of inquiries, complaints, comments, and final resolution. • Adheres to quality standards, regulations, and confidentiality through the various communication channels. • Participates in special projects as needed. • Performs other duties as assigned. • Complies with all policies and standards.