Member and Provider Service Supervisor

WellSense Health Plan

7d•Remote

About The Position

The Member and Provider Service Supervisor is responsible for ensuring the delivery of outstanding customer service, resolving issues, and delivering accurate information to WellSense members and providers. The role involves participating in the recommendation, development, and implementation of quality service strategies to improve member and provider satisfaction and operations. The Supervisor will also serve as a subject matter expert and resource as needed. This position is responsible for the direct supervision of Member and Provider Service Center staff, ensuring they have the necessary tools and resources to meet or exceed state contractual requirements and corporate standards. The Supervisor will proactively identify and resolve service barriers (claims, eligibility, enrollment, prior authorization, benefits) by collaborating with partner departments. They will work closely with the Member and Provider Service management team to ensure the highest levels of customer service, compliance with requirements and standards, and continuous improvement.

Requirements

Bachelor’s degree or an equivalent combination of education, training and experience is preferred.
Three or more years call center experience preferred.
Three or more years experience in healthcare or managed care is preferred.
Three or more years supervisory experience preferred, preferably in claims operations or claims data setting.
Demonstrates exceptional critical thinking and analytical skills.
Understands cause and effect and possesses strong problem-solving skills.
Strong oral and written communication skills and ability to interact within all levels of the organization.
Effective collaborative and proven process improvement skills.
A strong working knowledge of Microsoft Office products.
Demonstrated ability to successfully plan, organize and manage projects.
Detail oriented, excellent proof reading and editing skills.
Must be motivated, adaptable, flexible, and able to produce quality results in an evolving, fast paced environment.
Detail oriented, excellent organizational skills and ability to multi-task.

Responsibilities

Implements Member and Provider Service department policies, procedures and standards, and supervises Member and Provider Service telephonic and office operations to achieve productivity targets, quality standards and operational goals.
Participates in the development of policies and procedures to ensure outstanding service delivery and member and provider satisfaction.
Responsible for the daily analysis of call volumes, monitoring and adjusting staff resources (scheduling) to meet inbound demands (provider) and performance goals and maximize efficiency.
Ensures monthly compliance with corporate standards.
Establishes, maintains and refines intradepartmental and interdepartmental processes and procedures to support Member & Provider Services work processes across product lines.
Monitors staff to ensure compliance with established workflows.
Resolves first line policy questions referred by staff and works with partner supervisors and managers as needed to resolve.
Ensures Member & Provider Services staff has the technology and training needed to provide outstanding customer service.
Works in close collaboration with the Trainer to identify training opportunities (and optimum delivery method) to enhance customer service through the use of metrics and staff feedback. Trains or oversees training of staff.
Works as a member of the Member & Provider Services management team to ensure appropriate work allocation and adherence to all state requirements by sharing resources when necessary.
Conduct one-on-one quality feedback sessions with direct reports to coach and develop the team.
Take client/ customer calls and fill in for Assists as needed.
Monitors call trends to proactively identify existing and potential member and provider service issues.
Assists and participates as needed in budget planning.
Contributes to development and maintenance of member and provider materials.
Maintains current knowledge of WellSense and payment and reimbursement policies, member coverage and benefits, and claims adjudication rules.
Maintains current knowledge of WellSense benefits, provider network development and contract issues, Massachusetts Medicaid regulations, state and WellSense payment and reimbursement policies and industry standards for claims processing issues.
Maintains current knowledge of FACETS Customer Service Module, AVAYA, CCMS, and all systems used by Member & Provider Services staff and management.
Leads project activities including assigning tasks, determining project schedule and resolving project issues.
Represents department on cross-functional initiatives.
Performs other tasks as needed as a member of the Member and Provider Service management team to meet the goals of Member & Provider Services and WellSense.