Job Description

FLSA Status: Exempt
Department: Customer Service
Reports To: Director, Customer Service

GENERAL DESCRIPTION OF POSITION

The Manager of Customer Service provides day-to-day leadership and management to meet organizational goals and objectives. The incumbent has direct responsibility to develop, implement, and monitor all customer service activities in accordance with state and federal regulatory requirements, SCFHP policies and procedures and business requirements as set forth for each line of business.

ESSENTIAL DUTIES AND RESPONSIBILITIES

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below.

1. Plan, supervise and manage the day-to-day department activities related to customer service call handling and transportation to ensure timely handling of member and provider calls to meet customer service performance objectives.
2. Manage the process of non-telephone tasks and activities, including, but not limited to resolution of exempt grievances, outbound call projects, member billing issues and communications sent through email or the SCFHP member and provider portals.
3. Oversee performance of customer service representatives; collaborate with the Manager, Customer Service Quality and Training to ensure that staff are properly trained and receive ongoing training and support to maximize competency and performance.
4. Collaborate with internal stakeholders to develop, maintain and improve training materials and department resources.
5. Measure, monitor, analyze, and report trend of performance service metrics at a department and individual to measure effectiveness and service levels.
6. Work cross-functionally with other business units to identify trends driving call volumes and support initiatives to identify and implement interventions to reduce avoidable calls and improve customer service quality.
7. Implement solid operational processes to support timely and accurate customer service to members and providers in compliance with regulatory requirements and company objectives; identify operational issues and formulate appropriate solutions.
8. Understand and manage reporting requirements for assigned lines of business in accordance with state and federal regulatory requirements and timelines. Conduct quality reviews of reports; track and trend, share information with other departments as needed and develop recommendations to improve operational procedures and staff performance.
9. Implement processes to support new and existing programs, membership, benefits.
10. Develop, implement, monitor, and maintain customer service policies and procedures in accordance with state and federal regulations.
11. Lead and facilitate regular Customer Service team meetings and in-service sessions, coordinate staff participation in member/provider education with all operational departments.
12. Ensure that positive and productive relationships are developed, cultivated and maintained with other SCFHP departments.
13. Contribute information necessary to inform the design, configuration, evaluation, and monitoring of the telephone system, including call routing, messaging, and on hold-messages, seeking to improve the customer service experience.
14. Participate in and represent customer service in meetings, committees and audits as needed.
15. Perform other related duties as required or assigned.

SUPERVISORY/MANAGEMENT RESPONSIBILITIES

Carries out supervisory/management responsibilities in accordance with the organization’s policies, procedures, applicable regulations and laws. Responsibilities include:

1. Providing effective leadership to attract and retain top talent to drive business results, including recruiting, interviewing, and hiring.
2. Developing a high performing department culture and staff. This includes setting the standard for staff/peers and motivating employees to maximize organizational goals and objectives.
3. Effectively assimilating, training and mentoring supervisors and staff and (when appropriate), cross training existing staff and initiating retraining. This includes coaching to help increase skills, knowledge and (if applicable) improve performance.
4. Setting goals, key performance initiatives, and planning, assigning, and directing work consistent with said goals. This includes responding to employees’ needs, and ensuring they have the necessary resources to do their work.
5. Appraising performance, rewarding and disciplining employees, addressing complaints and resolving issues. This includes providing regular and effective feedback to employees and completing timely and objective performance reviews

REQUIREMENTS – Required (R) Desired (D)

The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.

1. Bachelor’s Degree in Business, Healthcare Administration or a related field or equivalent experience, training or coursework. (R)
2. Minimum of three years of health plan experience in a lead or supervisory capacity. (R)
3. Strong knowledge of Medi-Cal and/or Medicare managed health care. (R)
4. Strong knowledge of customer service principles and best practices. (R)
5. Sound understanding of health plan operations and the ability to monitor and understand trends in the industry and regulatory environment. (R)
6. Ability to establish and maintain effective internal and external working relationships. (R)
7. Ability to understand and apply practical implications of applicable rules, laws, regulations, program requirements, and industry guidance, and adjust direction as necessary to comply with regulatory requirements. (R)
8. Excellent communication skills including the ability to express oneself clearly and concisely across all levels of the organization, with external constituents and with regulators, over the telephone, in person, in presentations or in writing. (R)
9. Working knowledge and the ability to efficiently operate all applicable computer software including a working knowledge of and proficiency in, MS Office Suite applications including Outlook, Word, Excel, PowerPoint and Visio. (R)
10. Ability to use a keyboard with moderate speed and a high level of accuracy. (R)
11. Ability to think creatively and work strategically. (R)
12. Ability to produce accurate and precise work, detect discrepancies and resolve discrepancies all while meeting deadlines. (R)
13. Ability to understand, interpret, and apply applicable rules, regulations, and establish, evaluate and manage priorities. (R)
14. Self-directed with proven ability to assume responsibility, work independently, meet deadlines, prioritize, and move projects to completion with minimum supervision. (R)
15. Ability to take initiative and exercise good judgment when making decisions within the scope of the position. (R)
16. Ability to think and work effectively under pressure. (R)
17. Ability to maintain confidentiality. (R)
18. Ability to comply with all SCFHP policies and procedures. (R)
19. Ability to perform the job safely and with respect to others, to property, and to individual safety. (R)
20. Maintenance of a valid California’s driver’s license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R)

WORKING CONDITIONS

Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to regular contact with co-workers, managers, external partners, and vendors, in person, by telephone, and via work-related electronic communications.

PHYSICAL REQUIREMENTS

Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:

1. Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R)
2. Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R)
3. Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R)
4. Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R)
5. Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R)
6. Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R)

ENVIRONMENTAL CONDITIONS

General office conditions. May be exposed to moderate noise levels.