Member and Provider Services Supervisor

17 hours ago

Johnston, United States Delta Dental of Iowa Full time
Job Type

Full-time

Description

Come Smile with Us

Are you a strong leader with a passion for helping others ? Join our mission-driven team at Delta Dental of Iowa as a Member and Provider Services Supervisor where you will lead day to day contact center operations of assigned team. You will conduct interactions with providers and covered members regarding benefit clarifications, claim resolution, eligibility, payment, and general information regarding products and services. You will also suppor other supervisors, contributing to a collaborative working environment. This is your opportunity to support a high performance culture, drive continuous improvement, and foster a sense of community and purpose within the team while surpassing peformance objectives. This position is located in Johnston, Iowa and hours are 9:30 a.m. to 6:00 p.m.

Why Delta Dental of Iowa?

For your smile. For your health. For your community.

At Delta Dental of Iowa, we're more than just a dental and vision insurance company. Improving health and wellness is at the center of everything we do. As a not-for-profit, we aim to build stronger communities by investing in actions that promote and improve health. Delta Dental of Iowa invests 40% of our dollars directly back into the communities we serve.

Come see why we are passionate about "Bringing Smiles" to our customers. Our team enjoys competitive pay and benefits, an awesome "One Team" approach, and a company culture that fosters "Exceptional Quality Service" and "Leadership at All Levels." Together, we can make a difference - not only in Iowa but across the country.

Essential Functions and Principal Accountabilities:
  • Lead staff and work processes to ensure individual goals of the staff, team, and department are met in support of corporate objectives.
  • Monitor changes to schedules of staff including documenting and communicating all scheduled/unscheduled occurrences to the team. Address any performance issues regarding schedule adherence and expectations.
  • Perform monthly staff quality reviews. Coach staff members and the team related to performance results, including but not limited to quality assurance results for phone etiquette, claim processing, and overall goals.
  • Hire, train, develop, and lead a team of employees who are highly motivated and focused on timely and high quality results for stakeholders.
  • Track and monitor daily workload to ensure customers, stakeholders and internal operations expectations are met.
  • Communicate departmental information so that staff and department leadership remain informed of current issues, announcements, and changes to our processes or products.
  • Manage metrics such as wait times, call volumes, and claim backlogs to ensure high quality standards for stakeholders are met or exceeded. Make quick, independent decisions on shifting of staff to meet service level agreements.
  • Become subject matter expert for team's area of focus. This includes Member & Provider Services for Commercial and Government Programs, Individual, and Marketplace.
  • Assist in resolving escalated issues, including but not limited to claim problems and phone calls.
  • Support Marketplace through file maintenance and updates. Share knowledge of electronic files and paper eligibility data to ensure timely and accurate membership information is recorded within the administration system. Oversee that the eligibility files are completed according to specifications, review any data records contained in discrepancy reports.
  • Create a team environment that generates innovation and empowerment by cross-training staff in all aspects of claims/customer service.
  • Represent company in a highly energized, positive, professional and effective manner at all times.
  • Establish and maintain a positive team working relationship with all co-workers and internal and external stakeholders.
  • Recommend and actively participate in implementing process improvements.
  • Adhere to processing standards related to quality, documentation and turnaround time.
  • Comply with the policy and procedures at all times, including the DDPA standards as applicable.
  • Maintain strict confidentiality; adherence to all HIPAA laws is required at all times. Job requires confidentiality with regard to information acquired in carrying out the job functions.
  • Lead and/or participate in special projects on time and with high quality. May include assisting with requirements, perform testing, documentation, training.
  • Dependability in attendance and punctuality required.
  • Perform other duties as assigned.

Requirements

  1. Bachelor's degree or three to five years applicable experience in a customer service environment. Previous supervisory and/or leadership experience managing to production and quality objectives strongly preferred. Previous experience in an ACD Call Center environment preferred.
  2. Knowledge of insurance reimbursement practices, i.e. processing claims, processing policies, deductibles, maximums, Coordination of benefits (COB) and dental terminology preferred.
  3. Ability to develop and motivate staff to achieve departmental objectives and in a positive, team environment.
  4. Excellent written and verbal communication skills.
  5. Demonstrated ability to interact with internal and external stakeholders in an effective and positive manner.
  6. Demonstrated competency in computer skills, including Microsoft Excel and Word, as well as other software as required.
  7. Ability to analyze information and make independent decisions.
  8. Ability to work independently and as part of a team to complete assigned tasks and achieve goals.
  9. Demonstrated ability to prioritize, organize and function effectively with multiple tasks/assignments.
  10. Ability to meet with stakeholders and respond to their questions and concerns in a professional manner.
  11. Ability to troubleshoot basic computer or technology problems.
  12. Competency in basic math skills.

Delta Dental of Iowa is an Affirmative Action and Equal Opportunity Employer committed to providing equal employment opportunity for all persons without unlawful regard of race, color, religion, sex, sexual orientation, gender identity, age, national origin, individuals with disabilities, protected veteran status, or any other legally protected basis.

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