Job Description

Location:

Work from home (Pennsylvania)

Shift:

Days (United States of America)

Scheduled Weekly Hours:

40

Worker Type:

Regular

Exemption Status:

YesSupervises, develops and manages a team of Customer Service Representatives to ensure customer service standards, accreditation and regulatory requirements are met. Serves as a resource for communication and access to services for staff, members, providers, employers, and other organizational customers. Reports and trends customer issues. Reviews, develops, and provides on-going training and educational tools to staff. Assist with site visits, plans, directs and controls activities of the Customer Service staff to meet the operational needs and goals of the department. Manages activities of the Customer Service staff to ensure accurate and timely completion of all customer related inquiries. Pulls data and analyzes reports of production and quality metrics and recommends changes to staffing, policies or processes. Responsible for resolving complaints, considering nature and complexity of complaint, requirements of governmental agencies, and policies. Works directly with customers on escalated issues that require management intervention.

Job Duties:

• Provides leadership and developmental assistance to customer service team through daily interactions and monthly one on one meetings with all direct reports.
• Conducts monthly team meetings and involves staff in decision-making.
• Promotes activities that recognize and reward staff achievement.
• Creates and maintains standards, operational activities and performance measurement tools that meet operational and market needs in operational efficiency, quality, access and member satisfaction.
• Ensures timely and productive execution of planned customer service and education.
• Manages resource allocation in order to realize efficient production and maintain customer service performance standards.
• Assures adequate staffing levels and schedules in conjunction with appropriate productivity measures.
• Manages outbound call campaigns to foster education and retention of members, increase awareness of benefits and procedures, and develop and maintain relationships while adhering to regulatory agencies and service guarantees.
• Performs supervisory duties such as attendance monitoring, performance evaluations, disciplinary actions, etc.
• Interviews and selects prospective employees assuring qualifications and skills are met.
• Handles Human Resource issues with regard to Performance Improvement Plans, interpersonal issues, and leave requests.
• Serves as a resource and support to Customer Service personnel and other departments within the health system in the pursuit of knowledge and resolution of problems.
• Supports and defines goals, policies, and procedures.
• Participates in and leads interdepartmental strategic teams to alleviate any barriers customer service representatives have in completing duties.
• Responsible for regulatory compliance.
• Manages Federal regulatory compliance of all Medicare Advantage Processes and compliance of prompt payment provision of State and Federal Regulation.
• Provides input in budget preparation.
• Processes accurate adjudication and payment of claims processing.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

*Relevant experience may be a combination of related work experience and degree obtained (Associate’s Degree = 2 years; Bachelor’s Degree = 4 years).

Position Details:

Education:

High School Diploma or Equivalent (GED)- (Required)

Experience:

Minimum of 6 years-Relevant experience* (Required), Minimum of 2 years-Managerial/Supervisory (Required)

Certification(s) and License(s):

Skills:

Communication, Customer Retentions, Customer Service, HR Policies, Standards And Procedures, Service Request Management Process

OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities.

• KINDNESS: We strive to treat everyone as we would hope to be treated ourselves.
• EXCELLENCE: We treasure colleagues who humbly strive for excellence.
• LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow.
• INNOVATION We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
• SAFETY: We provide a safe environment for our patients and members and the Geisinger family.

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality.

We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.