Performs planning and direction setting. Manages customer service representatives and/or billing or enrollment representatives. Handles personnel issues with a team approach. Ensures that service standards are achieved. Acts as a patient advocate. Jointly responsible for the daily operations in order to develop and maintain a superior call center or membership service center. Lead the business processes. Ensure best practice customer service and/or membership administration while maximizing revenue. Responsible for the implementation of operational and technology best practices to improve compliance capabilities and efficiencies. Establishes and assures adherence to budgets, schedules, work plans and performance requirements in an effort to avoid paying out department performance guarantees of over three million dollars. Responsible for large-scale24 hour seven day a week call center that provides customer service for California and for the Regions outside of California.
Essential Functions:
- Manages the day to day operations of a line of business that provides customer service and/or membership, enrollment or billing services to members of the health plan
- Represents the Health Plan within the local community on benefits and service matters
- Collaborates with Benefits, Contracts and Government Program divisions of KP to interpret contract language and handle member concerns
- Ensures the timely intervention of member issues in order to enhance member satisfaction, member recruitment/retention
- Partners with KP departments, salesand marketing, customers and other stakeholders
- Manages a team of customer service representatives or member services representatives
- Develops schedules
- Assigns and monitors work
- Gathers resources
- Measures and monitors service performance quality standards to ensure customer satisfaction and to comply with regulatory agencies
- Recommends changes in guidelines, procedures, policies
- Provides operational direction to team and resolves operational issues
- Attracts, selects and maintains a qualified, motivated staff which involves interviewing, coaching, counseling, disciplining, advising, monitoring, training, terminating
- Implements line of business strategies
- Performs financial management, tracking, analysis and management of accounts receivables to ensure financial goals for the line of business are met
- Conducts analysis of data and reports to improve employee performance
- Impacts the achievement of department and/or functional objectives
- Erroneous decisions/recommendations or failure to achieve results may cause delays in program schedules and result in the allocation of more resources and additional funds
- Involves interpreting and analyzing administrative or technical concepts
- Judgment is required to make decisions for less defined issues
- Requires moderately complex decision-making
- Recognizes linkages and understands impact of individual actions on other parts of the organization and member / customer
- Works on issues where analysis of situation or data requires review of relevant factors
- Requires considerable amount of analysis to consider all alternatives for identified, yet complex, problems
- Follows operational policies in selecting methods and techniques to determine the best solutions
- Information to solve the problem comes from a variety of sources which may not be readily available
- Assume other duties as directed
Qualifications:
Basic Qualifications:
- Requires one (1) to three (3) years supervisory or management experience in member services, health care, call center, or financial fields. Other education or training (beyond the bachelor's degree) can suffice in place of a portion of the required supervisor experience. Satisfactory completion of a twelve (12) week course in Principles of Management offered by the Member Service Call Center can suffice in place of six (6) to nine (9) months required experience
- Experience in administration requiring extensive complex problem solving and high-level negotiations preferred
- Experience in preparing and conducting audits preferred
- Experience in a Labor/Management partnership environment strongly preferred
- Experience using mainframe or personal computer database, word processing, and statistical analysis software packages preferred
- Four (4) year degree in business administration, health care, or related field or equivalent experience required.
- The equivalent experience must be additional experience beyond the minimum work experience required above.
- Requires knowledge of membership management and working knowledge of another functional area.
- Knowledge of labor contracts and HR/Organization/Department policies and procedures
- Strong interpersonal and communication skills; excellent written and verbal skills
- Call Center knowledge or related knowledge
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.