Responsible for supervising, developing and managing a Team of Customer Service Representatives to ensure Health Plan 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 of the Geisinger Health Plan (GHP). Report and trend 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 of the Health Plan. Works directly with customers on escalated issues that require management intervention. Observes and evaluates workers' performance and recommends plans of action to improve performance, track GOALS. Hires, disciplines and discharges workers. Communicates with other departments and management to resolve problems and expedite work. Interprets and communicates work procedures and company policies to staff. Helps staff in resolving problems and completing work. Makes recommendations to management concerning staff and improvement of procedures.
Travel/special assignments at other locations as needed.
Reports to the Manager, Customer Service Operations.
COMPETENCIES AND SKILLS:
Demonstrates the ability to navigate through ambiguity and motivate staff in an ever-changing environment.
Demonstrates competence using Microsoft Office Word and Excel; Claim and Eligibility System Processor, Contact Center Documentation System, Pharmacy Claims Processor, COMPASS, Tower, Epic, Marx, and vendor websites/programs.
Demonstrates familiarity with database and reporting systems, as well as quantitative and qualitative analysis of data and statistics.
Demonstrates self-motivation and ability to manage, prioritize, and complete multiple projects in a timely fashion with limited supervision. Demonstrates an organized, flexible, and professional work style, with an understanding of business acumen.
Demonstrates strong time management skills.
Demonstrates ability to effectively train staff using presentations, group or individual training, in-services.
Demonstrates excellent verbal and written communication skills, interpersonal skills to lead and direct the efforts of others both internally and externally.
Demonstrates training and motivational skills to encourage staff development.
Demonstrates analytical and leadership skills and the ability to be an effective facilitator.
Demonstrates the ability to allocate staff and delegate tasks to meet standards, deadlines, and quotas, breaking complex problems into manageable projects to achieve successful results.
Demonstrates the ability to establish trust, respect, and credibility, and to form close working relationships with all levels of the organization.
Demonstrates the ability to plan, prioritize and organize claims workload for the claims unit.
Ability to coordinate large volumes of claims to ensure production standards and regulatory turnaround times are met.
EDUCATION AND EXPERIENCE:
Bachelor's degree in Business or a health-related field required. The appropriate mix of education and experience may be substituted for the degree.
Minimum two years managed care experience in a managerial or supervisory role or equivalent required.
WORKING CONDITIONS/PHYSICAL DEMANDS:
Work is typically performed in an office environment, travel to Geisinger Health Plan training and meetings, occasional travel to on-site open enrollment meetings. Must be available outside normal business hours to address and resolve departmental issues in a timely fashion.
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.
ABOUT GEISINGER: Geisinger is a physician-led health system comprised of approximately 30,000 employees, including nearly 1,600 employed physicians, 13 hospital campuses, two research centers, and a 583,000-member health plan Geisinger is nationally recognized for innovative practices and quality care. Geisinger serves more than 3 million people in central, south-central and northeast Pennsylvania and also in southern New Jersey with the addition of National Malcolm Baldridge Award recipient AtlantiCare, A member of Geisinger. In 2017, the Geisinger Commonwealth School of Medicine became the newest member of 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, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. For more information, visit www.geisinger.org, or connect with us on Facebook, Instagram, LinkedIn and Twitter.
** Does not qualify for J-1 waiver. We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
*Domestic partner benefits not applicable at Geisinger Holy Spirit.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh Food
Farmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencing
programs, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.
Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 13 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers.
What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.