Supervisor Customer Care - SHP Customer Service - Tech Way - Day Shift - Full Time

Customer Care Supervisor

Shift Start Time: 8 AM

Shift End Time: 5 PM

Additional Shift Information: Weekend Requirements: As Needed

On-Call Required: No

Hourly Pay Range (Minimum - Midpoint - Maximum): $34.170 - $44.090 - $49.370

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant's years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

The Customer Care Supervisor is responsible for overseeing the daily operations of the customer care team. This role will provide effective leadership in the Customer Care Contact Center through a commitment to performance management, offering accurate information and assistance in a courteous, compassionate, and timely manner. Supervises, develops and enhances the effectiveness of the Contact Center staff, as required to ensure the team provides the highest level of quality service to our customers. In addition to direct staff development, the supervisor is responsible for oversight of work production, coverage, and timeliness for all lines of business, with an emphasis of an assigned department job function. Reviews, analyzes, and reports on performance key metrics. Monitors team scorecards and quality, to improve overall customer experience and implement quality improvement initiatives. Fosters professional external and internal working relationships. Ensures staff have resources needed to provide excellent customer service. Accurately completes assignments within designated time frames. Actively participates in essential workgroup, team, and assigned client meetings. The supervisor will also handle complex customer inquiries and complaints, analyze customer service performance, and work towards continuous improvement of the customer experience. Consistently ensures that activities and initiatives focus on the Sharp Commitment to Excellence through Service (S), Quality (Q), People (P), Finance (F), Growth (G), and Community (C).

Required Qualifications

• H.S. Diploma or Equivalent
• 5 Years healthcare customer service or medical office experience.
• 1 Year leadership experience.

Preferred Qualifications

• Bachelor's Degree Related field
• Other: Coursework in medical terminology and/or medical billing

Essential Functions

• Customer Service: Provides prompt, accurate and excellent services to internal and external customers. Develops solid professional working relationships with various internal departments and units and, as required, vendors, providers, employers, brokers and/or other customers. Works collaboratively with other Plan and medical group departments to address customer questions and concerns, including Billing, Appeals and Grievances, Health Services, Enrollment, Claims, Research, and Underwriting. Works collaboratively with health care providers and office staff to facilitate access to care. Maintains a complex and evolving knowledge of health insurance and health care reform mandates. Participates in client conference calls and attends client meetings as requested by Customer Care Manager. Complete routine reporting to accurately capture metrics, KPIs, and team performance. Supports team members through performance management and scorecard development and reporting. Understand and resolve complex member inquires/complaints by phone. Understand and resolve complex Medicare member inquiries/complaints by phone. Understand and resolve Covered CA escalation requests. Understand and resolve complex Commercial digital member inquires. Understand and resolve complex Medicare digital member inquires.
• Department Supervision: Leads, motivates, and supports staff to ensure they are providing exceptional customer service. Arranges departmental activities, monitors productivity and workflow, and ensures operational efficiency and quality of services. Establishes and maintains departmental policies and procedures; ensures appropriate review and revision. Anticipates resource needs and organizes staffing and workflow to meet customer demand, expectations, timelines, and deadlines. Ensures compliance with applicable contract terms, legal/regulatory requirements and accreditation standards. Identifies and resolves operational problems and inefficiencies to ensure quality service, achieve required results, and promote staff morale and job satisfaction. Provides on-call support to after hours call center in evenings and on weekends.
• Human Resource Management: Interviews and hires staff. Develops staff to maintain lowest levels of attrition. Monitors performance. Provides ongoing coaching, counseling, guidance, and, as needed, corrective action. Establishes and monitors staff workload, schedules, and attendance. Ensures consistent application of human resources policies and Sharp Health Plan protocols.
• Quality Improvement: Demonstrates knowledge of specific enrollment, benefit, and premium information for commercial (group and individual) and Medicare products. Complies with regulatory and accreditation requirements and timelines for customer service, including DMHC, CMS, and NCQA. Monitors staff performance in providing excellent customer service. Ensures customer issues are resolved in an appropriate and timely manner, in compliance with established policies, indicators and benchmarks. Reviews quality and appropriateness of services through case review, problem resolution and follow-up. Identifies opportunities for improved efficiency and cost effectiveness, and works with Manager, Customer Care to design and implements action plans. Makes recommendations to the Manager, Customer Care on process improvements with the goal of enhancing quality and customer satisfaction.
• Training and Education: Assesses staff skill levels and training needs. Works with Manager, Customer Care to identify training priorities and design training programs. Develops and maintains processes for training staff on Plan benefits, processes, and materials. Trains staff on new technology as appropriate, including all Managed Care systems. Under the direction of the Customer Care Manager, educates the staff on legislative and regulatory requirements as they affect relevant processes.
• Workflow Management: Responsible for accurate and efficient scheduling of call center resources, to ensure adequate coverage during business hours. Plans workflow and regularly monitors productivity and progress toward goals. Handles escalated customer issues and provides a resolution in a timely and effective manner. Identifies and resolves operational problems and inefficiencies to ensure continued high-quality service to internal and external customers, achieve required operational results, and promote staff morale and job satisfaction.
• Department Policies and Procedures: Demonstrated ability to resolve complex customer inquiries. Reviews and updates knowledge articles. Participates in at least two cross-functional work groups. Coach and support reps to effectively address member inquiries. Monitors inbound call volume and staffing to maintain productivity (RTA). Adheres to company and department policies.
• General Support: Participates in special projects and other duties as assigned. These may include, but are not limited to, work groups, proposals, audits and back-up support for other departments.

Knowledge, Skills, and Abilities

• Strong leadership and performance management skills.
• Demonstrated ability to exercise sound judgment and maintain confidentiality.
• Superior interpersonal skills; effective oral, written and presentation skills.
• Demonstrated ability to resolve complex customer inquiries.
• Ability to effectively participate in the activities of the Customer Service area and assist in the management of personnel.
• Exceptional diplomacy skills as required to effectively resolve issues under sometimes tense and stressful circumstances.
• Ability to analyze and interpret data and reports and make recommendations for further action.
• Knowledge of current matters relating to health maintenance organizations, performance management, and customer satisfaction assessment and delivery.
• Demonstrated knowledge of Sharp Health Plan benefits, policies and procedures.
• Ability to correspond, timely, clearly and accurately with customers verbally and in writing (grammar, spelling, tone, etc.).
• Knowledge of performance evaluation procedures.
• Computer skills, including word-processing, spreadsheets, and Managed Care Applications.
• Bilingual preferred but not required.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class.

Sharp HealthCare