Customer Service Manager - Medicare Advantage

Company: Partners Healthcare
Location: Somerville
Posted on: June 22, 2022

Job Description:

A career at AllWays Health Partners is you in every way! Inspired by our affiliation with Partners HealthCare, our promise as a people-first organization starts with our employees. Get inspired to bring your unique talents to our diverse community and challenge the health care industry status quo with innovative programs that put people first. Our perks include a competitive benefits package, access to world-class doctors, and more.The Manager of the Customer Service CenterMedicare Advantageis responsible for managing the day to date activities of the Medicare Advantage Call Center. The Manager is responsible for ensuring compliance with all applicable performance standards and regulatory, contractual, and corporate policies and procedures.The Manager must ensure maximum effectiveness of call center staff with a focus on efficiency and service excellence. The CSC staff is a highly diverse and multi-generational staff working in a dynamic and ever changing environment.The Manager will be expected to utilize industry-standard operational metrics to measure individual and departmental performance.In addition to managing the day to day activities of the Call Center, the Manager is an active, visible participant on many cross-functional teams which address strategic and business projects such as cost savings measures, infrastructure efficiencies, regulatory and contractual requirements, and break/fixes.Responsibilities: Act as a key advocate for customer service excellence within the Customer Service Center and across the organization. Provide leadership, development and mentoring of the supervisors and staff in order to create a high performance service culture that is aligned with AllWays Health Partners' strategic goals, objectives, and core values. Meet the short and long-term Call Center metrics and goals that incorporate enhanced first point-of-contact resolutions and seamless service processes. Ensure that all contractual service level expectations are achieved and that the department is in compliance with all regulatory requirements and standards, specifically how they pertaian to CMS regulations. Continuously assess whether current metrics are accurately reflecting customer preferences and needs. Ensure departmental compliance with HIPAA privacy regulations.Provide leadership to ensure member information is kept confidential through verification, access and restriction of information when appropriate. Makes necessary changes in staffing based on day of week and other anticipated and unanticipated events. Monitors productivity of customer service representatives and generates reports. Maintains harmony among workers and addresses conflicts. Inform, engage, inspire, motivate, and actively listen to employees. Make decisions that put the needs of the people we serve-our members, providers, brokers, and employers-front and center. Communicate and cascade information to employees in a timely manner and actively participate in the success of cross-organizational programs and initiatives. Identify/create processes and align resources to accomplish key objectives; clearly convey and assign clear accountability for important objectives, deadlines, and expectations. Hire, participate in, and/or recommend development measures and disciplinary actions up to and including termination; evaluate performance and supervise the work of all direct and indirect reports following established organizational policies, procedures, and practices. Set clear goals and objectives, use metrics to measure performance, and hold employees accountable. Provide coaching to improve performance and holds regular development meetings. Ensure diversity, equity, and inclusion are integrated as a guiding principle. Hold self and others accountable to meet commitments. Persist in accomplishing objectives to consistently achieve results despite any obstacles or setbacks. Build strong relationships and infrastructures that designate AllWays Health Partners as a people-first organization. Participates in CMS audits and mock audits including preparing materials for review. Strong knowledge of Medicare Operations policies, procedures, and systems. Refine and monitor key performance indicators (KPIs) for the Medicare Advantage program. Intervene as needed and escalate any issues where performance falls outside of expected levels. Provide an executive summary regularly senior leadership on these indicators. Manages outsourced Medicare advantage call center to ensure quality and compliance to CMS guidelines.QualificationsQualifications: BA/BS Degree or the equivalent combination of training and experience 5 years experience in a leadership role within a Medicare Managed Care planKnowledge of Call Center metrics, leading practices and relevant technologies. Demonstrated effectiveness working with CMS and Medicare Compliance Programs

Keywords: Partners Healthcare, Somerville , Customer Service Manager - Medicare Advantage, Executive , Somerville, Massachusetts