Supervisor, Medical Customer Service

Moda Health•Milwaukie, OR

8d•Hybrid

About The Position

Provides supervision to a team of customer service representatives fielding calls from multiple sources regarding a wide range of plan types. Organizes staff, sets goals, ensures resources are available as needed, coaches and monitors representatives to develop their skills and knowledge in dealing with members, policyholders, brokers, providers, Sales & Account Services, and others. Ensures calls are handled promptly, professionally, accurately, and courteously. Evaluates reports and results to ensure goals are achieved. Works collaboratively with the Medical Customer Service leadership team and the training department.

Requirements

High School diploma or equivalent.
2-4 years’ experience (preferably including experience as a lead, trainer, or supervisor), including one or more of the following: claims processing, customer service, claims support.
Strong reading, writing and verbal communication skills.
Strong interpersonal skills necessary to deal with complex or challenging issues and people.
Demonstrated analytical, problem solving and decision-making skills, particularly in a fast-paced environment.
Microsoft Office experience, including Outlook, Word, Excel, and PowerPoint.
Ability to maintain confidentiality and project a professional business presence and appearance.
Ability to come in to work on time and daily, working the hours required to support the team and meet all goals and objectives.
Must be able to work well under the pressure of frequent interruptions, the pressure to make good decisions on problems resulting from phone calls, the pressure of rapidly shifting priorities and the pressure of questions from many sources on many subjects.
Must be able to adapt to frequent changes in policies and procedures, sometimes with short notice.

Responsibilities

Handles verbal inquiries/complaints from callers, and answers questions from Customer Service Representatives and numerous internal departments.
Works with internal departments and external entities (providers’ offices, federal and state health insurance marketplaces, other carriers, and others) to obtain answers to caller questions as needed, and coordinate resolution of more complex caller issues.
Understands and continually works to gain additional knowledge in policies and procedures surrounding benefits, claim processing and adjustments, appeals and authorizations, and has the ability to communicate this information accurately and concisely to staff and callers.
Reviews and analyzes benefits on new and renewing groups and individual plans and communicates to staff information they will need to provide excellent service to callers.
Communicates with Benefit Configuration, Billing and Eligibility, Provider Relations, and Sales to clarify benefits, intent, and procedures to provide customer service.
Monitors Customer Service Representatives’ phone skills, delivery of accurate information and timely, complete follow-up from caller issues.
Monitors Customer Service Representatives’ work habits, including schedule adherence, time available to take calls, time management and work to be completed during downtime.
Provides direction to Customer Service Representatives sets clear expectations and reviews performance monthly.
Handles personnel administration including timekeeping, performance appraisals, interviewing and hiring, counseling, coaching and performance improvement plans.
Reviews, analyzes, and develops process improvement implementation plans to ensure departmental processes are efficient, and continues to evaluate and modify plans as needed to ensure continued success.
Works with the Training department and other departments as needed to ensure that Customer Service Representatives are well-trained, and information documented is clear and accurate.
Works collaboratively with all Medical Customer Service leadership including director, managers, supervisors, leads and trainers to ensure clear, consistent communication of goals and processes across the department.
Writes, reviews, updates, and communicates new and revised processes and procedures, including writing and updating procedure manuals, job aids, website postings, emails and training materials.
Participates in inter-departmental and cross-departmental meetings, committees, and projects.
Performs other duties as assigned.