Customer Care Resolution Specialist

CareSource

. Serve as a subject matter expert while staffing the assist line and responding accurately to inquiries from Customer Care Specialists .

Posted 10/2/2026full-timeRemote • Ohio • United StatesJunior💰 $47,400 - $76,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in Customer Care processes, with a strong ability to deescalate difficult conversations and provide effective coaching and feedback. Proficient in claims and coding, with a solid understanding of Medicaid and adherence to HIPAA regulations.

Highest-signal resume keywords

Customer Care ExperienceClaims And Coding ExperienceCoaching And Feedback SkillsProblem Solving SkillsHIPAA Compliance

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims And CodingICD9CPT4HCPCSRevenue CodeDental CodingComputer ProficiencyWindows EnvironmentTyping Speed Of 35 WPMAttention To Detail

Soft Skills

Excellent Written And Communication SkillsProfessional Phone EtiquetteCritical ThinkingListening SkillsAbility To Multitask

Tools & Technologies

ServiceNowAssist Line Tracking Database

Certifications & Qualifications

CareSource University Functional Facilitator Certification

Industry Keywords

Customer CareMember ServicesProvider ServicesHMOMedicaid

Tech Stack

Tools & technologies

ServiceNow

About the role

Key responsibilities & impact

Serve as a subject matter expert while staffing the assist line and responding accurately to inquiries from Customer Care Specialists
Handle and resolve escalated calls from members and providers
Act as a New Hire Transition Coach for new employees
Identify process gaps and partner with the Business Integration Team to resolve them
Provide peer-to-peer feedback and identify training needs for Customer Care Specialists
Manage and process incoming work from route boxes, faxes, email, web inquiries, and ServiceNow queues
Partner with other departments to achieve internal service levels
Maintain SME status through self-education and procedural updates
Document second-level support questions in the Assist Line Tracking Database
Assist members and providers with routine service inquiries
Research, follow up on, and resolve open or pending issues
Create and conduct departmental training as business needs require after completing CareSource University Functional Facilitator certification
Perform other duties as requested

Requirements

What you’ll need

High School education or equivalent required
Minimum of one (1) year experience in Customer Care (Member Services or Provider Services) required
Minimum of three (3) years customer service experience in a call center preferred
Minimum of two (2) years of HMO or related industry experience preferred
Strong understanding of Customer Care processes
Ability to deescalate difficult conversations
Ability to determine root cause of problems and propose solutions
Computer proficiency with knowledge and experience in a Windows environment
Typing speed of 35 WPM
Claims and Coding Experience (ICD9, CPT4, HCPCS, Revenue Code and Dental Coding)
Excellent written and communication skills
Professional phone etiquette
Proper use of grammar
Ability to work in a fast paced environment
Adaptable to a constantly changing environment
Attention to detail
Ability to multitask
Ability to work independently and with a team
Critical thinking and listening skills
Decision making and problem solving skills
Ability to coach and provide feedback effectively
Understanding of Medicaid
Must adhere to an assigned daily work schedule and have predictable and reliable attendance
Must adhere to all HIPAA and State requirements/regulations

Benefits

Comp & perks

Bonus tied to company and individual performance may be available
Substantial and comprehensive total rewards package
Employee total well-being support