Supervisor - Call Center Operations (11:30 a.m. - 8:00 p.m. / Hybrid - Troy, MI) - Health Alliance Plan

Henry Ford Hospital•Troy, MI

27d•Hybrid

About The Position

To supervise, organize and coordinate the HMO, Medicare Advantage and Federal Government call center operations associated with HAP's Customer Service Department, which includes lobby, written/electronic correspondences, and clerical operations. To maximize service levels through scheduling, floor management activities, coaching employees and managing performance for service excellence. To maintain and report on all information related to member inquiries received via the telephone, lobby and written inquiries received throughout the HAP system.

Requirements

Bachelor's Degree in Health Care, Business or a related field or a minimum of four (4) years recent and related work experience in customer service may be considered in lieu of the degree.
Minimum of two (2) years of experience in health care or insurance environment with focus on Medicare managed care products.
Minimum of two (2) years of recent supervisory or team lead experience with evidence of driving customer service improvements.
Must demonstrate excellent verbal and written communication skills.
Demonstrate positive leadership and interpersonal qualities at all times, maintaining the highest degree of tact and diplomacy when working with people.
Must demonstrate a high degree of maturity, poise, flexibility and good judgment in responding to inquiries from customers and when coaching employees.
Must demonstrate strong analytical and problem-solving skills.
Be able to meet multiple deadlines and manage progress of several projects simultaneously.
Have a clear understanding of health care delivery systems.
Working knowledge of Medicare Advantage Programs.
Knowledge of CMS Compliance regarding customer satisfaction.
HMO health care concepts.
Obtain and have on-going knowledge of CMS regulations and Medicare managed care concepts.
Demonstrate technical understanding of computer systems and be proficient in using a PC.

Responsibilities

Supervise, develop, coordinate and control all workflow activities in the Customer Service Department (which includes phone monitoring, scheduling staff & adjudicating the phone queue assignment schedule, based on trends to maximize the efficiency of the call center productivity.
Ensure compliance with the Centers for Medicare & Medicaid Services (CMS) and other regulatory agency guidelines, such as NCQA.
Determine and create training materials, policies, procedures and required telephone scripts related to customer servicing.
Maintain quality control within Customer Service based on live monitoring of calls, member feedback via letters, phone, e-mail via HAP's website, member survey cards, and quality audits performed by the department Quality Auditors.
Evaluate employee performance, initiate appropriate coaching and developing and implement disciplinary action within area of responsibility.
Develop the Call Center Statistical Analysis Reports on a daily/monthly/annual basis, including developing all associated written policies and procedures.
Focus on continuous improvement that will improve the customer experience.
Interface with the Client Services Correspondence and Grievance sections to be involved in the integral part of resolution for member complaints/grievances received by HAP.
Develop processes/measures that will ensure staff receives continuing education on most current benefits, products, policies, procedures, systems tools, in cooperation with the departmental Training Specialist.
Assist and/or handle member complaints received through the President's Office, Board of Directors, Media, Insurance Bureau, or the Department of Public Health ensuring a focus of customer satisfaction in complaint resolution.
Coordinate with Marketing, Membership & Billing, Pharmacy, and Finance Divisions in the resolutions of service related problems.
Work closely with the Compliance Office to ensure service delivery is consistent with regulatory agency requirements (NCQA, DFIS, DOL, HIPAA and CMS).
Perform other related duties as assigned.