Supervisor - Member Services Supervisor

3 weeks ago

Chula Vista, United States Community Health Group Full time

***

Supervises the daily activities of Member Services Specialists (MSS) and coordinates daily operations. Acts as liaison between membership, provider, CHG management, and staff on issues related to member representation. Works closely with staff to maintain performance benchmarks within acceptable guidelines.

**COMPLIANCE WITH REGULATIONS**:
Works closely with all departments necessary to ensure that the processes, programs, and services are accomplished in a timely and efficient manner by CHG policies and procedures and in compliance with applicable state and federal regulations including CMS and/or Medicare Part D and Special Needs Plan (SNP).

**RESPONSIBILITIES**
- Oversees and monitors the department’s daily operations.
- Trains new employees and conducts regular in-service training for current staff on how to provide accurate information to members and the community.
- Works to ensure compliance with all regulatory requirements including those from DHCS and CMS.
- Evaluates employee performance and works with the Manager to counsel staff when there are performance problems or issues.
- Prepares and motivates the (MSSs) as they implement outreach and enrollment activities.
- Responds to non-routine and difficult situations when the MSSs need assistance.
- Runs, analyzes, and submits a variety of statistical and activity reports to the Manager every month.
- Provides coaching and support to the MSSs, including assisting in difficult situations or issues and working with the member reassignment process.
- Participating in continuous quality improvement activities including live call and recorded call monitoring to ensure the accuracy of information and the quality of customer service provided by the MSSs.
- Resolve customer service issues by working with MSSs to identify internal and external operational issues preventing the delivery of good customer submitting recommendations for resolution.
- Coordinate department training by assessing department training needs and assists in developing training curriculum.
- Maintains schedules by coordinating work and vacation schedules for MSSs to ensure adequate coverage at all times, reviewing time cards and ensuring timely and appropriate completion/submission.
- Monitors member reimbursements by reviewing staff requests for member reimbursement and recommends action.
- Controls performance benchmarks and timelines by monitoring telephone call traffic and working with staff to maintain telephone abandonment rate and other departmental performance benchmarks within acceptable guidelines.
- Maintains product and company reputation and contributes to the team effort by conveying a professional image and accomplishing related tasks; participating on committees and in meetings; performing other duties as assigned or requested.

**Qualifications**:
**EDUCATION**
- BA degree. In healthcare-related fields preferred.

**EXPERIENCE/ SKILLS**
- Two (2) years of experience in public assistance, human or health services programs, and a minimum of one (1) year of experience supervising the work of others.
- Experience with and sensitivity to cultural background and linguistic needs of membership. Familiarity and respect for special social needs of the Medi-Cal population.
- Knowledge of Medi-Cal program eligibility requirements and familiarity with services available through community-based, ethnic service, and advocacy organizations throughout San Diego.
- Proficient in the use of PCs and Microsoft Office Suite. including proficiency in MS Word and Excel required, PowerPoint preferred.
- Some knowledge of County Social Services programs and Social Security Administration programs.
- Bilingual capabilities in English/Spanish or appropriate threshold language.
- Excellent communication and interpersonal skills.
- Ability to exercise mature and independent judgment.

**PHYSICAL REQUIREMENTS**
- Prolonged periods of sitting.
- Extensive telephone use may be required.
- May be required to work evenings and/or on weekends.

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