Supervisor, Support Center Operations

Molina Healthcare•Long Beach, CA

20h•$37,138 - $80,465

About The Position

Leads and supervises a team responsible for providing support center customer service excellence and claims adjudication to meet the needs of Molina members and providers. Ensures issues and needs are addressed fairly and effectively, and in alignment with Molina values. Demonstrates accountability for the delivery of product and service information, identifies opportunities to improve the member and provider experience, and supports continuous quality improvement initiatives related to member/provider engagement and retention. This position supports the claims department initiatives to improve overall claims function efficiency. Provides support for claims examination activities including evaluation of adjudication of claims to identify processing errors. Monitors and controls backlog and workflow of claims. Ensures that claims are settled in a timely fashion and in accordance with cost control standards. Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow-through to closure. Identifies claims requiring reprocessing or re-adjudication in a timely manner to ensure compliance. Makes recommendations for further investigation and/or resolution of claims. Collaborates with other functional teams on claims-related projects and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance. This position will support the closing shift which would need someone to work closing hours (i.e. 8:30am - 5pm PST/10:30am - 7pm CST/11:30am - 8pm EST).

Requirements

At least 5 years of customer service, call center and/or sales experience in a fast-paced/high-volume environment, including 3 years of call center experience, or equivalent combination of relevant education and experience.
Strong customer service skills.
Understanding of insurance products including Medicaid, Medicare and Marketplace/enrollment processes.
Organizational and time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
Ability to maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA).
Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and customers.
Ability to work cross-functionally across a highly matrixed organization.
Strong verbal and written communication skills.
Microsoft Office suite and applicable software programs proficiency.

Nice To Haves

This position prefers a candidate with strong claims experience.
Management/leadership experience.
Systems training/experience for the following: Microsoft Office, Microsoft Teams, Genesys, Salesforce, Pega, QNXT, CRM, video conferencing, CVS Caremark, Availity.
Managed care/health care experience.

Responsibilities

Provides leadership and oversight for the member and provider support center; ensures exemplary service is delivered according to Molina goals/objectives/policies/procedures and regulatory requirements, and demonstrates accountability for performance and financial outcomes.
Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow-through to closure.
Addresses more complex member inquiries, questions and concerns in all related areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care.
Provides exemplary customer service to customers including members, co-workers, vendors, providers, government agencies, business partners, and general public.
Achieves individual performance goals as it relates to call center objectives.
Demonstrates personal responsibility and accountability and leads by example through individual performance.
Ensures compliance with contractual and regulatory requirements.
Recommends and implements programs to support member and provider needs.
Supports projects and special initiatives as appropriate.
Sets a positive example for others and builds the Molina culture by modeling the Molina mission, vision and values in daily actions.
Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of department-specific goals.
Models dynamic leadership for support center representatives; develops team to focus on delivering great health care/customer service to underserved populations.