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Primary Objectives

To supervise, organize and coordinate the HMO, Medicare Advantage and Federal Government call center operations associated with HAP's Customer Service Department, which includes lobby, written/electronic correspondences, and clerical operations. To maximize service levels through scheduling, floor management activities, coaching employees and managing performance for service excellence. To maintain and report on all information related to member inquiries received via the telephone, lobby and written inquiries received throughout the HAP system.

Duties and Responsibilities:

+ Supervise, develop, coordinate and control all workflow activities in the Customer Service Department (which includes phone monitoring, scheduling staff & adjudicating the phone queue assignment schedule, based on trends to maximize the efficiency of the call center productivity.

+ Ensure compliance with the Centers for Medicare & Medicaid Services (CMS) and other regulatory agency guidelines, such as NCQA.

+ Determine and create training materials, policies, procedures and required telephone scripts related to customer servicing.

+ Maintain quality control within Customer Service based on live monitoring of calls, member feedback via letters, phone, e-mail via HAP’s website, member survey cards, and quality audits performed by the department Quality Auditors.

+ Evaluate employee performance, initiate appropriate coaching and developing and implement disciplinary action within area of responsibility.

+ Develop the Call Center Statistical Analysis Reports on a daily/monthly/annual basis, including developing all associated written policies and procedures.

+ Focus on continuous improvement that will improve the customer experience.

+ Interface with the Client Services Correspondence and Grievance sections to be involved in the integral part of resolution for member complaints/grievances received by HAP.

+ Develop processes/measures that will ensure staff receives continuing education on most current benefits, products, policies, procedures, systems tools, in cooperation with the departmental Training Specialist.

+ Assist and/or handle member complaints received through the President’s Office, Board of Directors, Media, Insurance Bureau, or the Department of Public Health ensuring a focus of customer satisfaction in complaint resolution.

+ Coordinate with Marketing, Membership & Billing, Pharmacy, and Finance Divisions in the resolutions of service related problems.

+ Work closely with the Compliance Office to ensure service delivery is consistent with regulatory agency requirements (NCQA, DFIS, DOL, HIPAA and CMS).

+ Perform other related duties as assigned.

Requirements:

+ Bachelor’s Degree in Health Care, Business or a related field or a minimum of four (4) years recent and related work experience in customer service may be considered in lieu of the degree.

+ Minimum of two (2) years of experience in health care or insurance environment with focus on Medicare managed care products.

+ Minimum of two (2) years of recent supervisory or team lead experience with evidence of driving customer service improvements.

Abilities

+ Must demonstrate excellent verbal and written communication skills.

+ Demonstrate positive leadership and interpersonal qualities at all times, maintaining the highest degree of tact and diplomacy when working with people.

+ Must demonstrate a high degree of maturity, poise, flexibility and good judgment in responding to inquiries from customers and when coaching employees.

+ Must demonstrate strong analytical and problem-solving skills.

+ Be able to meet multiple deadlines and manage progress of several projects simultaneously.

Knowledge

+ Have a clear understanding of health care delivery systems.

+ Working knowledge of Medicare Advantage Programs.

+ Knowledge of CMS Compliance regarding customer satisfaction.

+ HMO health care concepts.

+ Obtain and have on-going knowledge of CMS regulations and Medicare managed care concepts.

+ Demonstrate technical understanding of computer systems and be proficient in using a PC.

Additional Information

+ Organization: HAP (Health Alliance Plan)

+ Department: Customer Service

+ Shift: Day Job

+ Union Code: Not Applicable

Additional Details

This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.

Overview

Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services – from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford’s care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation’s most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus. Learn more at henryford.com/careers .

Benefits

The health and overall well-being of our team members is our priority. That’s why we offer support in the various components of our team’s well-being: physical, emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses and more. Employees classified as contingent status are not eligible for benefits.

Equal Employment Opportunity/Affirmative Action Employer

Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is

committed to the hiring, advancement and fair treatment of all individuals without regard to

race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,

weight, marital status, family status, gender identity, sexual orientation, and genetic information,

or any other protected status in accordance with applicable federal and state laws.