PURPOSE AND SCOPE:
Supports Fresenius Health Partners, Inc., and FMCNA’s mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and FMCNA policy requirements.
Directs and establishes key functions and activities for the department. Responsible for timely and accurate reporting of Operations results to FHP Management. Ensure compliance with governmental processing and reporting requirements and that internal and external reporting is timely and accurate. Oversight of the Member Services Call Center to provide accurate information as needed.
DUTIES / ACTIVITIES:
- Responsible for driving the FMC/FHP culture through values and customer service standards.
- Accountable for outstanding customer service to all external and internal customers.
- Develops and maintains effective relationships through effective and timely communication.
- Takes initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner.
PRINCIPAL RESPONSIBILITIES AND DUTIES:
Call Center Operations
- Designs and implements customer/member services engagement systems
- Outbound call processes for member and providers
- Inbound call processes for members and provider
- Productivity tracking and quality assurance monitoring of Customer Service calls both inbound and outbound.
- Manage operations of FHP Customer Service Call Center staff, meet specifications set by CMS and contracted clients.
- Implement CQI processes for operations performance improvement on a daily, monthly, quaterly basis.
- Assist in developing processes for and provide ongoing management of FHP member and provider operations department, including but not limited to new patient and Customer Service Productivity tracking and reporting, customer service issue resolution, and insurance partner collaboration.
- Coordinate between Member/Provider Service and Clinical Services and Finance departments to ensure seamless delivery.
- Oversee Clinical Team Leader(s) and Customer Service Supervisor(s), ensuring appropriate and timely resolution of member and provider issues, in accordance with Corporate and governmental policy.
- Develop and maintain procedures as necessary to implement policy and respond to changed circumstances.
- Evaluate and recommend information system strategies to members of management.
- Actively develop recruiting, training and retention strategies to keep an engaged and productive work force.
- Plan career paths and succession strategies to provide the Company with sufficient human resources to meet future demands within area of control.
Other duties as assigned.
PHYSICAL DEMANDS AND WORKING CONDITIONS:
The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Day to day work includes desk and personal computer work. The position requires limited travel between field operations and various locations within the community.
- Bachelors Degree with major in Business Management or equivalent experiencerequired.
- Advanced degreepreferred.
EXPERIENCE AND REQUIRED SKILLS
- Minimum of six years Health Plan Customer Service experience with three years supervisory experience.
- Proficient with PC office applications.
- Strong management, analytical, communication, negotiating, and team building skills.
- Ability to motivate and lead others.
Job ID 18000E5C