Highmark West Virginia Inc.
Job Description :
Supervises and coordinates the day to day activities of the various call centers responding to inquiries received by members, providers, or account representatives across all markets. Select, develop and continuously coach staff to the highest levels of performance. Motivate and team build through the creation of a work environment and conditions that contribute to highest levels of performance.
1. Effectively supervise all assigned personnel:
- Responsible for monitoring and assuring acceptable levels of performance, productivity and quality are met for all personnel.
- Select, train, coach, mentor and motivate employees to maximize performance and behaviors. Monitor the performance of employees and implement corrective action for employees when performance and standards decline.
- Create a work environment that recognizes rewards and motivates employees to continuously improve business processes to add greater value to the products/programs offered.
- Provide career development opportunities to staff to maximize employee performance.
- Complete administrative tasks such as performance reviews, time and attendance, training requests, system access, move requests, disciplinary actions. Also, if offered, manage alternative work schedules or settings.
2. Monitor and manage daily inventories to ensure adequate staffing and resources are available to ensure performance guarantees and established goals are met and maintained. Monitor calls for quality assurance.
3. Oversee the performance of staff in the administration of service of these programs. Select, train, motivate and develop the staff to enhance their performance and behaviors. Create a work environment that recognizes rewards and motivates employees to continuously improve business processes to add greater value to the products and programs supplied to our members. Manage alternative work schedules and actively guide and coach employees provide career development to maximize performance.
4. Research quality issues and responds to error assessments. Maintain department logs and documentation, analyze for trends in order to identify and initiate future pro-active measures.
5. Ensure compliance with all regulatory entities (i.e., DOH, CMS, NCQA, etc.) Create, implement, monitor and report on the policies and procedures to ensure all required business/compliance standards are met. Represent the department compliance audits are it relates to the supervisor functions.
6. Subject matter expert for benefit plan and claims processing.
7. Other duties as assigned or requested.
Minimum Education and Experience
- High School/GED
- Two (2) years of experience in customer service and/or claims environment
- Three (3) years of experience in leading or supervising employees in a highly regulated operations environment
- Three (3) years of experience with complex service computer systems (ex. OSCAR, INSING) and inquiry/benefits and handling of phone, written or web inquires
Preferred Education and Experience
- Bachelor’s Degree
- Three (3) years of working experience and knowledge of procedures and terminology for all lines of business (ex. medical terminology, interpretation of pharmacy policies, dental terminology and policy, HARRIET, HCPCS codes, group benefits, complex pharmacy claim workflow (including claim adjudication of claim processing and/or rejections)
Knowledge, Skills and Abilities
- Knowledge of multiple processing systems and workflows.
- Knowledge of various telephone or call center systems.
- Knowledge of all company products.
- Knowledge all applicable regulatory agencies and policies, (examples include: Pennsylvania Insurance Department regulations, HIPAA, TEFRA, SOX and Act 83 and Highmark Operational and Corporate Policies).
- Ability to communicate well in person, via phone and via e-mail (verbally and written).
- Ability to clearly articulate processes and procedures to all staff and management personnel.
- Ability to communicate, interact, and work effectively and cooperatively with all levels of staff and management teams.
- Ability to write basic internal business memos and desktop procedures, root cause/resolution analysis and flows
SCOPE OF RESPONSIBILITY
Does this role supervise/manage other employees? Yes
Is Travel Required? Yes
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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