Customer Service Manager - Medicare Advantage
Company: Partners Healthcare
Location: Somerville
Posted on: June 22, 2022
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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
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