GENERAL SUMMARY:

To plan, direct, evaluate and coordinate the activities associated with the Call Center, as it relates to overall operations, key HAP initiatives, and service excellence; to maintain and report all member information for HAP's enrolled population; to maintain and report customer inquiries and complaints received in the call center that will assist with forecasting and planning; to maximize coach and counsel the staff to exceed performance levels incorporating diplomacy, accuracy and timeliness in all customer contacts. Strategizes the planning, developing and directing of the call center operations and customer service programs.

PRINCIPLE DUTIES AND RESPONSIBILITIES:

• Provide overall direction and oversight to the Call Center in its day-to-day operations, which includes the development, planning, staffing and coordination of activities as they pertain to divisional and corporate initiatives, strategies and objectives.
• Use data analytics to drive performance and set clear team goals and Key Performance Indicators (KPIs).
• Develop reporting within Genesys for call center oversight including SLA, adherence, AHT, empathy/sentiment, quality and more.
• Monitor the quality of written, telephone and personal responses to HAP's members and potential subscriber inquiries, problems and complaints. Determine training, policy, procedure and benefit needs relating to customer service as a result of quality trends.
• Ensure regulatory mandates, as it relates to department operations, remain in compliance, which includes adhering to CMS, NCQA, MDHSS, and HIPAA guidelines.
• Determine and implement training, policy, procedure and benefit needs relating to customer servicing.
• Assist in handling all member complaints received through the President's office, State Insurance Bureau, Office of Personnel Management or via media, telephones and lobby. Maintain an on-going relationship with support departments and respective Medical Directors for the resolution of sensitive and routine member problems relating to HAP providers and policies and procedures.
• Interview, evaluate and select personnel for the Call Center. Evaluate employee performance, initiate appropriate coaching and development, corrective and disciplinary action. Promote a positive work environment through culture and employee engagement activities .
• Prepare and administer the annual budget.
• Monitor the overall service performance, where there is service degradation and develop and implement remediation plans to meet service expectations which may include creating CAPs, CIPs or policies and procedures.
• Coordinate the activities with the Sales, Marketing and Finance Divisions of current/potential employer groups and special governmental programs including but not limited to RFPs and client audits.
• Prioritize the continuous enhancement of customer service excellence and the development of staff in a customer-oriented, customer-centric manner. Manage vendors delegated to perform specific plan operations.
• Supervise, develop, coordinate and control all workflow activities in the Customer Service Department (which includes phone monitoring, scheduling staff & adjudicating the phone queue assignment schedule, based on trends to maximize the efficiency of the call center productivity).
• Learn and Administer Union contracts, including participating in grievance meetings, timely communication of operational changes with the union.
• Evaluate and provides regular feedback on staff performance on a regular basis.
• Lead efforts to perform telecom systems testing.
• Comprehensive knowledge of Medicare rules and regulations, including appeals, grievances, the annual election period, Medicare Advantage plans, Part D, and ANOC and EOC documentation.
• Knowledge of Commercial group plans and open enrollment.
• Knowledge of insurance claims and drug formularies.
• Understanding of provider networks and provider directories.
• Perform other related duties as assigned.

EDUCATION/EXPERIENCE REQUIRED:

• Bachelor's Degree in Health Care, Business or a related field or eight (8) years progressive experience in a health care or insurance environment.
• Four (4) years progressive experience in a health insurance environment.
• Three (3) years previous supervisory experience in a business/health care environment.
• Three (3) years of customer service management experience in a moderately large call center operation preferred.
• Must understand and have used basic accounting principles and math.

EXPERIENCE Preferred:

• Understanding of Genesys telecom platform.
• Experience with Pega and/or Salesforce CRM.

Behaviors:

• Proven managerial skills.
• Strong organizational and communication skills, both verbal and written and the ability to express ideas logically, cogently and persuasively.
• Excellent analytical and decision-making skills.
• Ability to comprehend and suggest modification to technical computerized systems or other applications as it relates to call center operations.
• Abilities to learn the HAP policies, procedures and benefits.
• Skills to develop a good understanding of the Henry Ford Health System (HFHS) and the HAP provider network.
• Exhibit a thorough understanding of health care delivery systems.
• Displays strong human relations and interpersonal management skills.
• Proven technical expertise in database-oriented computer systems.
• Proven proficiency in using Microsoft Office applications, including Word, Excel, and PowerPoint.

• Organization: HAP (Health Alliance Plan)
• Department: Customer Service
• Shift: Day Job
• Union Code: Not Applicable