Supervisor, Medical Customer Service

About Moda Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together. Let’s do great things, together! Position Summary This is a FT Hybrid position based in Milwaukie. This position provides supervision to a team of customer service representatives fielding calls from multiple sources regarding a wide range of plan types. Organizes staff, sets goals, ensures resources are available as needed, coaches and monitors representatives to develop their skills and knowledge in dealing with members, policyholders, brokers, providers, Sales & Account Services, and others. Ensures calls are handled promptly, professionally, accurately, and courteously. Evaluates reports and results to ensure goals are achieved. Works collaboratively with the Medical Customer Service leadership team and the training department. Pay Range $65,682.16 - $82,107.97 annually (depending on experience) Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range. Benefits Medical, Dental, Vision, Pharmacy, Life, & Disability 401K- Matching FSA Employee Assistance Program PTO and Company Paid Holidays Required Skills, Experience & Education High School diploma or equivalent. 2-4 years’ experience (preferably including experience as a lead, trainer, or supervisor), including one or more of the following: claims processing, customer service, claims support. Strong reading, writing and verbal communication skills. Strong interpersonal skills necessary to deal with complex or challenging issues and people. Demonstrated analytical, problem solving and decision-making skills, particularly in a fast-paced environment. Microsoft Office experience, including Outlook, Word, Excel, and PowerPoint. Ability to maintain confidentiality and project a professional business presence and appearance. Ability to come in to work on time and daily, working the hours required to support the team and meet all goals and objectives. Must be able to work well under the pressure of frequent interruptions, the pressure to make good decisions on problems resulting from phone calls, the pressure of rapidly shifting priorities and the pressure of questions from many sources on many subjects. Must be able to adapt to frequent changes in policies and procedures, sometimes with short notice. Primary Functions Handles verbal inquiries/complaints from callers, and answers questions from Customer Service Representatives and numerous internal departments. Works with internal departments and external entities (providers’ offices, federal and state health insurance marketplaces, other carriers, and others) to obtain answers to caller questions as needed, and coordinate resolution of more complex caller issues. Understands and continually works to gain additional knowledge in policies and procedures surrounding benefits, claim processing and adjustments, appeals and authorizations, and has the ability to communicate this information accurately and concisely to staff and callers. Reviews and analyzes benefits on new and renewing groups and individual plans and communicates to staff information they will need to provide excellent service to callers. Communicates with Benefit Configuration, Billing and Eligibility, Provider Relations, and Sales to clarify benefits, intent, and procedures to provide customer service. Monitors Customer Service Representatives’ phone skills, delivery of accurate information and timely, complete follow-up from caller issues. Monitors Customer Service Representatives’ work habits, including schedule adherence, time available to take calls, time management and work to be completed during downtime. Provides direction to Customer Service Representatives sets clear expectations and reviews performance monthly. Handles personnel administration including timekeeping, performance appraisals, interviewing and hiring, counseling, coaching and performance improvement plans. Reviews, analyzes, and develops process improvement implementation plans to ensure departmental processes are efficient, and continues to evaluate and modify plans as needed to ensure continued success. Works with the Training department and other departments as needed to ensure that Customer Service Representatives are well-trained, and information documented is clear and accurate. Works collaboratively with all Medical Customer Service leadership including director, managers, supervisors, leads and trainers to ensure clear, consistent communication of goals and processes across the department. Writes, reviews, updates, and communicates new and revised processes and procedures, including writing and updating procedure manuals, job aids, website postings, emails and training materials. Participates in inter-departmental and cross-departmental meetings, committees, and projects. Performs other duties as assigned. Working Conditions & Contact With Others Office environment with extensive close PC and keyboard use, constant sitting, and frequent phone communication. Must be able to navigate multiple computer screens. A reliable, high-speed, hard-wired internet connection required to support remote or hybrid work. Must be comfortable being on camera for virtual training and meetings. Work in excess of standard workweek, including evenings and occasional weekends, to meet business need. Internally with all departments, most commonly Healthcare Services, Membership Accounting, Privacy and Security, Marketing, Sales, Provider Relations, Claims Support, Information Technology, Benefit and Provider Configuration. Externally with members, service providers, caregivers, policyholders/employers, brokers, other carriers, State agencies, and all others who call in to Medical Customer Service. Together, we can be more. We can be better. Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training. For more information regarding accommodations, please direct your questions to Kristy Nehler & Danielle Baker via our View email address on click.appcast.io email. #J-18808-Ljbffr Moda Health