Job Description

The Member Services Supervisor upholds and administers the Member Service Department functions as set forth by the Member Services Manager and oversees the daily calls and activities to ensure all member issues are resolved accurately, timely and are handled appropriately by Member Services Representatives.

Oversees Customer Service Operations:

  • Coach and counsel Member Service staff
  • Review all complaints/grievances taken from Reps
  • Monitor call volume and abandonment rate thru GNAV
  • Prepare monthly reviews on attendance, tardiness, monitors scores
  • Prepare annual performance appraisals as required
  • Prepare and present corrective actions as needed
  • Monitor calls for quality purposes
  • Prepare time edits for payroll, review paid time off request
  • Maintain attendance record from the attendance line
  • Meet with Director on a regular basis to assess departmental operation and activities
  • Ensure new employees are adequately trained
  • Complete performance appraisals and 30-Day monthly evaluations as scheduled
  • Complete at least 2 quality monitors on each employee per month.
  • Accurate time keeping and payroll reporting
  • Ensure that PTO is recorded and correct
  • Ensure that attendance is correctly maintained in employees file

Assist members in utilizing the health plan to meet their health care needs:

  • Educate and assists members on proper utilization of the health plan
  • Research and follow up on unresolved complaints
  • Contact provider offices to facilitate problem resolution
  • Assist in reducing abandonment calls by taking calls, if necessary
  • Resolve 97% of member complaints on first contact, including documentation and logging
  • Support achievement of department abandonment rate of 5% or less
  • Uphold commitment to customer service quality standards
  • Handle escalated member calls that cannot be resolved by the Lead

Assign and notify PCPs of all new incoming enrollees and exiting members:

  • Oversee assignment of PCPs to all new enrolled members according to zip code and age
  • Oversee/assist provider offices with eligibility verifications
  • Assists members in making PCP changes

Qualifications:

Knowledge:

  • Proper customer service techniques
  • Knowledge of health plans preferred

Skills:

  • Computer experience necessary
  • Effective time management skills
  • Effective interpersonal and communication skills
  • Use of a multi-line phone

Abilities:

  • Bilingual in English-Spanish preferred
  • Work respectfully and positively with members and providers
  • Ability to manage multiple projects and prioritize work tasks to adhere to deadlines and identified time frames
  • Ability to handle escalated customer concerns
  • Complete tasks with little supervision
  • Ability to supervise and lead others
  • Ability to think analytically and make independent decisions
  • Ability to manage large workload
  • Ability to maintain a positive work environment for employees
  • Ability to maintain positive work relationships
  • Able to problem solve
  • Able to handle fast paced high stress situations

Education:

  • High School Diploma or GED equivalent
  • Some college preferred

Experience:

• At least two (2) years customer relations / customer service background preferred

• Previous healthcare experience preferred

• At least two (2) years supervisory experience

• At least two (2) years call center experience

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

Apply Online