Team Leader Member Relations - JHP

Job Details

This position reports to the Member Relations Manager. The team leader works with minimal direction in coordination with the Member Relations Supervisor and Management. Responsibilities include but are not limited to responding to complex external and internal inquiries in a professional, informative, and courteous manner (10-15% on the phone). This role requires mastering and demonstrating skills and concepts within the call center environment. Demonstrates the ability to think outside of the box to identify, resolve, and assist the team with the handling of complex inquiries. Support and represent the Member Relations team. Assist in formulating department guidelines, coordinate projects and assist with staff training when needed.

Job Description

Primary Responsibilities:

• Directs staff in performance according to standards of practice, state and federal regulations, accreditation agencies and company policies and procedures.
• Serves as the point person/technical resource for issues regarding all lines of business.
• Anticipate and identify causes of interruption in unit functions and takes appropriate action to meet performance expectations.
• Develop, among staff, a consciousness for the need for teamwork to attain departmental objectives. As well as direct staff in a constructive and positive manner to foster positive employee relationships.
• Recommend candidates for hire to the Manager based on subjective and objective findings identified by using a standardized interviewing tool.
• Ensures that reports are completed, accurate, and timely to meet regulatory and company regulations.
• Attend and assume a leadership role in Team meetings, staff meetings, and all external cross-functional meetings.
• Attends external meetings as representative of Health Partners Plans and represent department at meetings which have an impact on Call Center operations and reports on the same.
• Assist Member Relations Representative with accurate benefit information for callers.
• Assist in the coordination of special assignments including reports and departmental projects.
• Provide phone coverage on high call volume days to provide telephone support as required and handle calls which escalate beyond the Member Relations Representatives abilities.
• Act as a liaison to member’s who request one-on-one assistance.
• Provide Floor Support.
• Member Relations Macess Inventory Oversight.
• Responsible for the documentation of operating procedures.
• Collaborate with leadership and support team to set up touch point meetings with an agenda. Provide recommendations and feedback based off team performance.
• Tracking/Trending of call volumes and escalated matters, reporting on trends and issues that impact the Member Relations Department.
• Coordinate cross-functional and interdepartmental initiatives.
• Schedule and assist with the facilitation of team meetings, and huddles.
• Adhere to the following turn-around times for issue resolutions via e-mail, Macess, in-person, etc.
• Follow Department guidelines on response time and resolution (acknowledgement) for standard inquiries and, expedited issues.
• Evaluate staff quality performance utilizing coaching tools as a resource for improvement.
• Mentoring staff using intense one on one coaching sessions as a means of performance enhancement.
• Facilitate mini group and individual training sessions to support staff with knowledge gaps to perform across functional discipline.
• Review staff’s monthly audit appeals for accuracy and appropriateness of submission.
• Provide supervision and support to Call Center staff, including participating in the monthly.
• On Call rotation cycles which provides 24/7 support.
• Attend SQC and Fair Hearing meetings to provide interpretation and feedback as needed.
• Other duties as assigned.

Key Job Requirements:

• Education:
• High School Diploma or equivalent work experience.
• 3-5 years progressive customer service experience across multiple disciplines preferred.
  
  Skills/Abilities:
• Excellent written and verbal communications skills.
• Bilingual a plus, but not necessary.
• Ability to work independent of direct supervision, but also must be able to work within a team.
• Proficiency in Departmental Information Systems including DPW, Member Health Information System and Pharmacy Systems.

Medicare Advantage Compliance Statement: Compliance with all applicable rules, regulations and laws is a condition of employment. Employees must read and sign, both the Business Code of Conduct and the Personal Standard Code of Conduct, and are expected to perform their duties ethically and honestly.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc.

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University , home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200 undergraduate and graduate programs to more than 8,300 students. Jefferson Health , nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps ), have access to medical (including prescription) insurance.

For more benefits information,