Manager Customer Service Quality - Geisinger Health Plan

Job Summary

Accountable for the development and implementation of quality strategies, plans, and processes to support organizational goals. Accountable for development of and ongoing compliance with NAIC (National Association of Insurance Commissioners) Model Audit Rule (MAR) requirements as they relate to all Customer Service Operational functions. Assesses quality needs as well as design, develop, deliver and maintain quality programs for onsite and remote employees. Provides direct supervision, oversight and development of staff.

Job Duties

• Develops and coordinates the execution of all Model Audit Rule requirements.
• Develops internal control procedures, and compliance reporting plans.
• Evaluates reports and findings with management and staff of all affected departments.
• Coordinates remediation efforts.
• Conducts quality needs analyses and consults key stakeholders to identify additional training needs.
• Determines key learning objectives which effectively describe outcomes of training and aid in the evaluation and measurement process.
• Identifies quality resources and innovative approaches that can be used to accomplish learning objectives.
• Coordinates external regulatory and vendor audits.
• Coordinates sample pulls, auditing of samples and acts as liaison when entities are conducting an on-site or off-site audit.
• Creates and utilizes quality evaluation tools that measure the effectiveness of training and the work being done on the floor.
• Evaluates quality programs and courses in an effort to identify how individual development needs are being met, and make recommendations for ongoing requirements of training and quality programs.
• Designs, develops, and delivers programs and materials relating to new hire on-boarding, product, system, soft skill, and organizational development.
• Selects, develops, motivates, trains and retains a competent staff to ensure appropriate staffing resources; perform annual staff performance reviews.
• Coordinates all quality activity; maintains quality audit schedule, resources and materials.
• Partners with internal department and vendors to stay abreast of new technologies, products, and trends to keep audits applicable and current.
  
  

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

• Relevant experience may be a combination of related work experience and degree obtained (Associate’s Degree = 2 years; Bachelor’s Degree = 4 years).
  
  

Position Details

Education

High School Diploma or Equivalent (GED)- (Required)

Experience

Minimum of 3 years-Managerial/Supervisory (Required), Minimum of 9 years-Relevant experience* (Required)

Certification(s) and License(s)

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. SAFETY: We provide a safe environment for our patients and members and 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. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.