Team Leader Member Relations
Health Partners Plans
- Erie, PA
- Permanent
- Full-time
- Competitive Compensation Packages, including 401(k) Savings Plan with Company Match and Profit Sharing
- Flextime and Work-at-Home Options
- Benefits & Wellness Program including generous Time Off
- Impact on the communities we service
- 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.
- High School Diploma or equivalent work experience.
- 3-5 years progressive customer service experience across multiple disciplines preferred.
- 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.