Customer Engagement Representative Lead

Position Purpose

The Engagement Center represents the front door of the organization to ensure health care is received timely with an exceptional customer experience. The Lead position provides front line support for the various teams of the Engagement Center as mentors and subject matter experts, remotely and on-site. The successful Customer Engagement Lead goes above and beyond to resolve escalated customer requests, support team members and leadership. This position will act as a liaison, primarily a patient advocate, between Renown, Hometown Health, its customers, and community members by processing requests, complaints, concerns, providing education in utilizing the resources and services of the organization, resulting in "first call resolution". This position serves as the backbone of the team and will ensure continual, exceptional team performance by addressing complex cases, maintaining knowledge base systems, and practicing continual process improvement. The role is a personally fulfilling one, with the opportunity to make a genuine difference in each life that is touched.

Nature and Scope

This position is responsible for support customers and team members while working in a fast-paced environment using several modes of communication including face-to-face, video conferencing, telephone, chat, messaging, and email. Serving as a resource for the team, the lead will take escalated or difficult calls and provide direct customer support needed.

A lead must have excellent interpersonal skills to understand customer inquiries or complaints and manage difficult conversations. Leads will act as the voice of the customer, advocating on their behalf to ensure they receive best in class service by proactively identifying and escalating priority issues, de-escalating when appropriate, and going above and beyond to meet customer needs. Leads will take lessons learned to inform process improvement and workflow changes. They must be able to learn quickly so they can acquire the service and product knowledge to answer customers' questions accurately. Their work must be concise and accurate. They must have a good knowledge of telephone and computer systems. The lead makes no medical necessity decisions.

The teams of the Engagement Center are an essential part of the Health Care Team, so patients can receive accessible and cost-effective care. To be successful, Leads must be proficient in maintaining relationships with a variety of stakeholders and serve as role model for the team through upstanding behavior and professionalism. Leads will be privy to confidential information and must always utilize discretion and maintain position scope. They will frequently move between various levels of work and will need to be agile and adaptable. While leads act as mentors and provide a degree of informal leadership and support to supervisors, they are not in a formal leadership role and do not have direct reports.

The Engagement Center operates 24x7x365. Leads must be willing to work at the times needed to provide service to meet customer needs. Some positions include evening, night, weekend, and holiday hours.

Incumbent will provide a variety of services. These can include, but are not limited to:
•Role model of professionalism and supports a culture of patient centeredness and just culture, "see something, say something".
•Provides support to team members as necessary to assist with education, training, escalated calls, and feedback to support process health and development.
•Identify areas of opportunity and perform root cause analysis for process improvement.
•Keep up-to-date on processes and business changes.
•Build and maintain team knowledge base systems including creating and maintaining standard work and process flows.
•Act as a subject matter expert in technical upgrades and advances to test and improve the product or process.
•Use critical thinking to remove barriers to maintain productivity and creative solutions when established policies and procedures fail to ensure customer satisfaction.
•Acts as key connecting point between team, Engagement Center leaders, as well as external departments to aid in issue resolution and process improvement.
•Follow established standard policies and procedures to complete pertinent tasks, accurate information intake/documentation and analysis meet customer needs, and work for one call resolution.
•Utilize conflict resolution skills as applicable; demonstrate effective listening skills and patience.
•Successfully complete special projects as assigned.
•Support team in answering and routing of high volume of inbound/outbound interactions through multiple channels and computer software systems. Assist with answering customers' requests as needed based on complexity of situation or volume. Communicating with customers to resolve inquiries using various platforms.
•Coordinating healthcare services including appointment scheduling (of all complexities), updating patient records, obtaining authorizations, communicating with care teams, arranging transportation, paging on-call physicians, escalating patient concerns, general compliant and grievance resolution, basic navigation of the healthcare system, providing technical support, and payment collection.
•Provide appropriate responses to customers regarding health plan benefits to include, but not limited to eligibility, benefit quoting, provider network, referral, and authorization process, claims payment, as well as policies and procedures.
•Handle inquiries related to compliance and regulatory auditing. Able to work through and resolve complex claims and payment processes.
•Perform service recovery to retain positive customer relationships and utilization of the health system to retain and promote customer loyalty.

Performs other duties as required as well to meet and exceed performance goals to ensure all departmental & organizational goals are achieved.

Disclaimer

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Minimum Qualifications
Requirements - Required and/or Preferred

Name

Description

Education:

Must have working-level knowledge of the English language, including reading, writing, and speaking English. A college degree or equivalent experience is preferred but not required.

Experience:

Successful completion of Customer Service Representative 1 or 2 OR equivalent experience or responsibilities.

2-3 years of experience in customer service, healthcare, or health insurance with demonstrated competence within 90 days of hire.

Previous mentor, training, or lead experience preferred.

Required to have strong customer services skills.

Ability to speak Spanish desired.

License(s):

None

Certification(s):

Certified Medical Insurance Specialist, Lean Six Sigma or Transformational Healthcare preferred but not required

Computer / Typing:

Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel, teams, Visio, and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc. Electronic medical record experience required. Ability to type average of 40 WPM.

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