Resp & Qualifications
PURPOSE:
Supervise and provides daily direction to multi-functional team members regarding training and development, policies, procedures, and work production quantity and quality. Functional areas may include but not limited to: installation, implementation, client support, client services, client administration, customer service, enrollment and eligibility, claims processing, and call center operations. Reviews and resolves complex service issues not resolvable by subordinates.
ESSENTIAL FUNCTIONS:
- Supervise employee outcomes by training, assigning, scheduling, coaching, and counseling employees; communicating job expectations; planning, monitoring, and appraising job contributions; adhering to policies and procedures.
- Meets operational standards by contributing information to strategic plans and reviews; implementing production, productivity, quality, and customer-service; resolving problems; identifying system improvements.
- Maintains customer service objectives by monitoring daily operations; resolving claims that require manual review or technical support, enrollment or billing related customer issues. Consistently reviews systems and makes necessary adjustments where needed, including resources/staffing. Researches and resolves escalated calls, review and resolve complex claims that have not been resolved by Claims staff.
- Maintains and improves departmental operations by monitoring system performance; identifying and resolving operations problems; supervising process improvement and quality assurance programs; installing upgrades.
- Prepares call center, claims and or enrollment and billing performance reports by collecting, analyzing, and summarizing data and trends.
- Improves call center, claims and or enrollment and billing job knowledge by attending educational workshops.
SUPERVISORY RESPONSIBILITY:
This position manages 2-10 people.
QUALIFICATIONS:
Education Level: High School Diploma or GED.
Experience: 3 years related professional experience with demonstrated leadership skills. Must have proficiency in the service, claims or enrollment & billing area.
Preferred Qualifications: Bachelor’s Degree.
- Familiar with the Market Prominence system
- Three – Five years of supervision experience
- Knowledge of Dual Eligible Special Needs Plans (DSNP)
- Ideal candidate will have experience with Membership Enrollment and/or Managed Health Care Experience
Knowledge, Skills and Abilities (KSAs)
- Knowledge of call center operations, claims and/or enrollment and billing and work flows.
- Strong presentation skills.
- Highly proficient in Microsoft Office programs.
- Excellent communication skills both written and verbal.
- Ability to plan, review, supervise, and inspect the work of others.
Department
Department:MD Medicaid-Enrollment
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship.
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