Description: Performs planning and direction setting.Manages customer service representatives and/or billing or enrollment representatives. Handles personnel issues with a team approach. Ensures that service standards are achieved. Acts as a patient advocate.Jointly responsible for the daily operations in order to develop and maintain a superior call center or membership service center. Lead the business processes. Ensure best practice customer service and/or membership administration while maximizing revenue. Responsible for the implementation of operational and technology best practices to improve compliance capabilities and efficiencies. Establishes and assures adherence to budgets, schedules, work plans and performance requirements in an effort to avoid paying out department performance guarantees of over three million dollars.
- Manages the day to day operations of a line of business that provides customer service and/or membership, enrollment or billing services to members of the health plan.
- Represents the Health Plan within the local community on benefits and service matters. Collaborates with Benefits, Contracts and Government Program divisions of KP to interpret contractlanguage and handle member concerns. Ensures the timely intervention of member issues in order to enhance member satisfaction, member recruitment/retention.
- Partners with KP departments, sales & marketing,customers and other stakeholders.
- Manages a team of customer service representatives or member services representatives.
- Develops schedules.
- Assigns and monitors work.
- Gathers resources.
- Measures and monitors service performance quality standards to ensure customer satisfaction and to comply with regulatory agencies.
- Recommends changes in guidelines, procedures, policies.
- Provides operational direction to team and resolves operational issues.
- Attracts,selects and maintains a qualified, motivated staff which involves interviewing, coaching, counseling, disciplining, advising, monitoring, training, and terminating.
- Implements line of business strategies.
- Performs financial management, tracking, analysis and management of accounts receivables to ensure financial goals for the line of business are met.
- Conducts analysis of data and reports to improve employee performance.
- If no bachelor's degree nor associate's degree, four (4) years of experience in a member services, health care, call center, or financial services role required.
- Bachelor's degree in business administration, health care, or related field OR four (4) years of experience in member services, health care, call center, or financial services role OR an associate's degree AND two (2) years of experience in an aforementioned relevant role.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- Requires knowledge of membership management and working knowledge of another functional area.
- Knowledge of labor contracts and HR/Organization/Department policies and procedures.
- Strong interpersonal and communication skills; excellent written and verbal skills.
- Minimum one (1) year supervisory or management experience in member services, health care, call center, or financial fields.
- Experience in administration requiring extensive complex problem solving and high-level negotiations preferred.
- Experience in preparing and conducting audits preferred.
- Experience in a Labor/Management partnership environment strongly preferred.
Job Number: 642187