Team Lead - Customer Relations

Hawaii Medical Service Association • Honolulu, HI

7d

About The Position

The Team Lead - Customer Relations mentors servicing representatives after classroom training, supports them with questions, listens to customer conversations, conducts quality assurance audits, and provides constructive coaching. The role also directly handles customer inquiries, including complex and escalated complaints, and coordinates with internal HMSA departments and external contacts to resolve customer needs.

The position requires comprehensive working knowledge of HMSA plan provisions, eligibility, benefits, claims processing, medical and payment policies, and administrative policies. The Team Lead helps the Contact Center meet or exceed Blue Cross Blue Shield Association Member Touchpoints Measures and other performance standards, analyzes representative performance, and collaborates with management and peers to support department goals and HMSA’s mission. Other responsibilities may be assigned or directed.

Requirements

• Associate’s degree and three years of customer servicing experience, or an equivalent combination of education and related work experience.
• Strong verbal, written, and interpersonal communication skills.
• Strong critical-thinking, research, decision-making, and problem-solving skills.
• Basic working knowledge of Microsoft Office applications, including Excel, Word, Outlook, and PowerPoint.
• Thorough and comprehensive working knowledge of HMSA plan provisions, eligibility requirements, benefits, claims processing, medical policies, payment policies, and administrative policies.

Responsibilities

• Mentor servicing representatives following classroom training and remain available to answer their questions.
• Circulate the floor periodically to listen to conversations and provide instruction.
• Conduct quality assurance audits for timeliness, accuracy, professionalism, and customer experience.
• Provide timely, relevant, professional, and constructive coaching.
• Analyze problems and create end-to-end resolutions, taking ownership of customer interactions to resolve needs in one contact whenever possible.
• Coordinate customer resolutions with HMSA departments and external contacts, including providers, employers, third party administrators, and other insurance companies.
• Independently manage inquiry volume by directly supporting inbound calls and other servicing channels while maintaining a high level of customer service.
• Help ensure that First Call Resolution and other performance measures and guarantees are met or exceeded, including inquiry accuracy, resolution timeliness, abandonment rate, average speed to answer, and Grade of Service.
• Research complex calls and benefits that require additional investigation.
• Create requests and coordinate resolution of customer complaints and issues, including individual consideration, HMO-G, grievance, and appeal requests.
• Generate monthly reports and analyze representatives’ key performance indicators and performance trends.
• Review representative best practices and improvement needs with supervisors.
• Personally handle elevated irate or complaint calls.
• Resolve complaints by assessing root causes, providing appropriate resolutions, and evaluating the effectiveness of HMSA policies and procedures.
• Provide feedback to staff, internal HMSA departments, and management.
• Collaborate with management staff and peers on activities that support HMSA’s mission and department goals.
• Perform other miscellaneous responsibilities and duties as assigned or directed.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree