Incident Management Specialist III, Employee Services

Kaiser Permanente•Pleasanton, CA

About The Position

In addition to the responsibilities listed below, this position is also responsible for processing routine Human Resources (HR) related transactions (e.g., benefits, leaves of absences, pay, transfers, new hires, disability, retirement, workers compensation) with limited supervision; retrieving, entering, and processing standard employee data using HR information systems; maintaining employee records and ensuring information is up to date with limited guidance; making calls to transaction initiators and handling incoming calls from employees and managers as needed; researching and responding to standard employee inquiries and escalating issues to senior team members as needed; identifying, investigating, and resolving standard HR related issues with supervision and escalating as needed; and complying with regulations, laws, organizational practices, and collective bargaining agreements with limited supervision. Essential Responsibilities: Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members. Listens to, seeks, and addresses performance feedback; provides mentoring to team members. Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; helps others adapt to new tasks and processes; helps others adapt to new tasks and processes. Supports and responds to the needs of others to support a business outcome. Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives. Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports, identifies, and monitors priorities, deadlines, and expectations. Identifies, speaks up, and implements ways to address improvement opportunities for team. Performs member, customer, or employee incident case management by: monitoring and analyzing the case tracking database to identify moderately complex, specialty, or flagged cases that require resolution as well as reporting trends to management; processing moderately complex and specialty/flagged incident cases; and ensuring compliance of own work with internal and external rules in the performance of case management activities with some review necessary. Performs member or employee incident case research by: investigating claims, authorizations, member contracts, and/or customer service interactions across members and customers to make determinations for moderately complex and specialty or flagged incident cases. Resolves member or employee incident cases by: making decisions regarding moderately complex or specialty/flagged incident cases through interacting with business leaders and other stakeholders; and resolving moderately complex or specialty/flagged cases and implementing case decisions. Performs customer service by: providing accurate information to members, customers, employees, or other stakeholders related to the status and outcomes of moderately complex or specialty/flagged cases in an appropriate timeframe; and communicating with and diffusing frustrated members, customers, or other stakeholders in moderately complex or specialty/flagged cases involving highly charged, sometimes emotional situations. Performs case documentation by: maintaining confidentiality of member, customer, or employee information throughout numerous documentation activities for moderately complex or specialty/flagged cases; and documenting moderately complex or specialty/flagged cases in accordance with all internal and external requirements.

Requirements

Minimum one (1) year of experience in customer service or a directly related field.
Bachelors degree in Business Administration, Economics, Health Care Administration, Health Services, Communications, or related field AND minimum two (2) years of experience in health care, health insurance, sales and marketing, or a directly related field OR Minimum five (5) years of experience in health care, health insurance, sales and marketing, or a directly related field.
Knowledge, Skills, and Abilities (KSAs): Information Gathering; Negotiation; Incident Management; Health Care Compliance; Maintain Files and Records; Data Entry; Acts with Compassion; Interpersonal Skills; Managing Diverse Relationships; Relationship Building; Stakeholder Management; Incident Escalation; Managing Complexity; Time Management; Service Focus; Adaptability; Stress Tolerance; Member Service; Patient Safety; Microsoft Office; Incident & Complaint Processes; Conflict Resolution

Nice To Haves

Responsibilities

Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members.
Listens to, seeks, and addresses performance feedback; provides mentoring to team members.
Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples.
Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; helps others adapt to new tasks and processes.
Supports and responds to the needs of others to support a business outcome.
Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives.
Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate; communicates progress and information.
Supports, identifies, and monitors priorities, deadlines, and expectations.
Identifies, speaks up, and implements ways to address improvement opportunities for team.
Performs member, customer, or employee incident case management by: monitoring and analyzing the case tracking database to identify moderately complex, specialty, or flagged cases that require resolution as well as reporting trends to management; processing moderately complex and specialty/flagged incident cases; and ensuring compliance of own work with internal and external rules in the performance of case management activities with some review necessary.
Performs member or employee incident case research by: investigating claims, authorizations, member contracts, and/or customer service interactions across members and customers to make determinations for moderately complex and specialty or flagged incident cases.
Resolves member or employee incident cases by: making decisions regarding moderately complex or specialty/flagged incident cases through interacting with business leaders and other stakeholders; and resolving moderately complex or specialty/flagged cases and implementing case decisions.
Performs customer service by: providing accurate information to members, customers, employees, or other stakeholders related to the status and outcomes of moderately complex or specialty/flagged cases in an appropriate timeframe; and communicating with and diffusing frustrated members, customers, or other stakeholders in moderately complex or specialty/flagged cases involving highly charged, sometimes emotional situations.
Performs case documentation by: maintaining confidentiality of member, customer, or employee information throughout numerous documentation activities for moderately complex or specialty/flagged cases; and documenting moderately complex or specialty/flagged cases in accordance with all internal and external requirements.