Manager Medical Customer Service

Moda Health•Milwaukie, OR

4d•Hybrid

About The Position

This is a FT Hybrid position based in Milwaukie, Oregon. This role develops and maintains customer service policies, procedures, and guidelines for multiple lines of business in Oregon, Alaska, Idaho, and Texas: Commercial medical groups, including ASO and fully insured groups, and Individual medical groups. This role also ensures prompt, efficient, and accurate information is provided to staff, members, providers, and group administrators. Works closely with supervisors and senior leadership to develop, implement, and ensure consistency of processes and procedures across each line of business. Responsible for staff organization, service-level performance, goal setting, coaching, motivation, and staff development.

Requirements

Bachelor’s degree or equivalent work experience specializing in business administration, customer service, and/or health insurance.
Minimum of four years of supervisory experience in medical, dental, and/or pharmacy customer service.
Demonstrated ability to effectively manage multiple lines of business concurrently.
Knowledge and understanding of Medicaid, Medicare, pharmacy, medical, and dental programs.
Ability to instruct, motivate, and direct individuals at various skill levels, both face to face and in a virtual environment.
Demonstrated strong, effective, and diplomatic interpersonal skills with employees at all levels.
Possesses and demonstrates strong presentation skills.
Excellent reading, oral, and written communication skills, with the ability to interact professionally, patiently, and courteously with internal and external customers.
Strong problem-solving and decision-making skills.
Ability to work well under pressure in a complex and rapidly changing environment.
Ability to maintain confidentiality and project a professional business presence and appearance.
Knowledge and understanding of contracts and administrative policies affecting claims.
Demonstrated consistent ability to comply with company rules and policies.
Maintains attendance above company standards.

Responsibilities

Manages and oversees all functions within the Medical Customer Service team.
Strives to ensure all Moda performance guarantees, NCQA requirements, call goals, voicemail callbacks and email statistical goals are met.
Provides mentoring and development for supervisors to ensure performance standards are met.
Participates in workgroups to offer solutions and suggestions that support department goals.
Manages current processes and develops innovative solutions to meet and exceed department measures and metrics.
Plans, organizes, and directs department workflow to ensure staff performance expectations, including quality and quantity goals, are reasonable and met.
Reviews performance issues with supervisors and takes disciplinary action when appropriate.
Drafts, implements, approves, and executes policies and procedures that support a quality customer service experience.
Assesses and oversees process improvement implementation plans to ensure departmental processes are efficient.
After process improvements are implemented, evaluates and modifies them as appropriate.
Ensures prompt, efficient, and accurate customer service administration by developing and implementing appropriate goals with the Director.
Reviews monthly, quarterly, and annual statistical reports.
Ensures language access contracts for member and provider vendors are in place and functioning as intended.
Provides written narratives and reviews data for quarterly NCQA reports for Commercial Medical in all states.
Provides direction to supervisors and keeps them informed of expectations and performance on a monthly basis.
Sets short-term and long-term objectives for supervisory staff and provides resources to ensure goals are met.
Provides constructive and timely performance evaluations.
Oversees hiring, training, orientation, performance appraisals, scheduling, and corrective action for staff.
Recruits, interviews, hires, and trains departmental supervisory staff.
Coordinates with the Training Manager, Operations teams, and supervisors to provide initial and ongoing staff training.
Works with the Director to review and advocate for departmental staffing projections and budget needs.
Recommends appropriate staffing requirements based on projected new sales and business retention.
Coordinates with Human Resources and supervisors to ensure departmental recruitment efforts remain on track.
Works cooperatively companywide with Claims, Membership Accounting, Marketing, Operations, Healthcare Services, Compliance, and Sales and Service Management.
Serves on project teams and committees for all areas as appropriate.
Provides annual review of plan documentation, websites, and benefit programs to ensure accurate annual updates for medical departments.
Provides oversight and direction for departmental involvement in various annual user acceptance testing projects.
Identifies areas for improvement within departments and across functions.
Leads improvement efforts where appropriate and evaluates and manages cross-training to maximize productivity.
Ensures phone lines are directed correctly for weekend and holiday coverage and are adequately staffed for Texas lines of business.
Performs other duties as assigned by leadership.