The Customer Service Team Leader for Medicare Advantage acts as a Subject Matter Expert within his/her team supporting the corresponding team Supervisor and members of the team by answering complex product-related claims, benefit and other questions from customers that front line Medicare Advantage Customer Service Professionals (CSPs) are unable to answer, also in handling supervisor-level customer escalations on behalf of the management team as needed.

This includes guiding Medicare Advantage Customer Service Professionals through calls and complex service delivery questions, supporting, coaching and mentoring via the delivery of feedback to their team's CSPs and the respective Supervisor. This also includes assisting with side-by-side training of junior professionals, performing or coordinating customer exceptions and one-time accommodations, as well as facilitating timely resolution of customer issues with internal and external constituent when warranted. Collaborates with Medicare Advantage leadership to help identify and develop departmental efficiencies.

In this role, this individual is also responsible for monitoring the inventory of pending customer requests specific to his/her team and contributing to the overall performance of the team specific to call handling and other metrics.

He/She acts as an informal leader focused on his/her own growth and development in this leadership capacity as well as contributing to that of his/her designated team.

Responsibilities:

• Ensures Medicare Advantage CSP guidelines and compliance with CMS regulations
• Identify trends within the Medicare Advantage team
• Provide daily direction to team members and ensure their awareness and understanding of information necessary such that calls are answered in a timely, efficient, and knowledgeable manner.
• Handle all complex customer requests and service-failure incidents with minimum or no supervision, including prospective customers when applicable.

• Thoroughly research and document customer items, and utilize current resources as needed when troubleshooting.
• Provide performance feedback and coaching on a regular basis to team members.
• Collaborates with QA and training to identify training and coaching needs of the team members.
• Assist the team's Supervisor in addressing and resolving issues raised by team members in support of the team's delivery of high-quality work and maintaining team members motivated to perform at their best.
• Share responsibility for the performance of his/her team specific to ensuring calls are handled efficiently and required metrics are met.
• Establish procedures and processes that support the department's standards and NHP's strategic directives.
• Support and mentor junior professionals and maintain corresponding Supervisor abreast of developing and coaching needs within the team.
• Provide continual evaluation of processes and regularly share with Customer Service management staff identified improvement opportunities.
• Assume management of team specific escalated or problem calls.
• Resolve requests in a timely, professional manner, including completing the call for the CSP if need be and/or offering advice that allows the CSP to finish the call on their own.
• Perform real time side-by-side assistance for CSPs by answering product related questions, handling escalated calls, walking an associate through a call, and other issues as they arise; coach CSP's on overall call flow and efficiencies.
• Anticipate, meet or exceed internal and/or external customer expectations and requirements; establish and maintain effective relationships with customers and gain their trust and respect.
• Work as a member/leader of process improvement related workgroups and/or special projects.

Basic Requirements:

Minimum 1 year MGBHP Customer Service

Job knowledge consistent with Member CSPs and Provider CSPs

Products Training - all lines of business

Excellent proficiency with all relevant systems

Claim experience - Member Claims & Provider Claims

Preferred Qualifications:

Respects the talent and unique contribution of every individual, culture and ethnic group and treats all people in a fair and equitable manner.

Exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.

Demonstrated adherence to MGBHP attendance policy

Demonstrates MGBHP Core Values of Service Excellence, Quality Care, Diversity, Responsibility and Relationships

Accountable for delivering high quality work

Cannot be on any performance management plan

Quality monthly scores must exceed 90% on a consistent basis

Consistent adherence to the department's call handling expectations and metrics

Strong attention to detail

Able to safeguard customers' privacy and confidentiality

Excellent multi-tasking, organizational and time management skills

Outstanding telephone soft skills - voice, tone, courtesy

Strong communication and listening skills

Able to adapt and/or thrive in high stress, fast paced environments

Outstanding customer service skills, specifically the ability to handle irate customers and appropriately defuse a sensitive situation

Adaptable, flexible, dependable

Excellent problem-solving skills and proven productivity

Strong interpersonal, influencing and negotiating skills

Proven record of delivering quality work

Ability to work in a team environment