Manager, Member Experience

Position Summary:

The Manager, Member Experience is responsible for call center operations, implementing call center strategy, improving systems and processes, and managing the operations staff. The ideal candidate must be able to lead and motivate teams, ensuring that Member Experience staff drive an excellent member experience, anticipate and address member needs, and are held accountable to results in member satisfaction and service level.

General Duties/Responsibilities (May include but are not limited to):

·         Define and monitor performance and productivity standards specific to those systems that must be in place to serve the health plan’s enrolled population.

·         Maintain high knowledge of procedures, protocols, benefits, services, systems, and any other necessary information to resolve member issues and inquiries.

·         Ensure that Member Experience staff possess the skills and training necessary to communicate effectively with the plan’s membership.

·         Oversee the hiring and onboarding of new Member Experience hires.

·         Ensure Member Experience staff answer the incoming phone queue calls according to CMS defined standards and according to department protocols.

·         Prepare Key Performance Indicator reports for distribution to key stakeholders.

·         Prepare performance reports by collecting, analyzing, and summarizing data and trends on production and quality.

·         Identify call drivers and root causes, coordinating with leadership for mitigation.

·         Participate and support discussions and other related activities for the Company’s CRM development and implementation.

·         Assist with the review and development of new department policies and procedures as needed.

·         Develop and encourage a spirit of cooperation, teamwork, and accountability among all department employees.

·         Provide direct reports with clear, concise, and appropriate communications and directions.

·         Ensure direct reports are compliant with all department/company policies and procedures.

·         Guide, mentor, and coach direct reports for professional development and to deepen their technical skill sets (i.e., CRM, TalkDesk, BICC, etc.,).

·         Review and respond to Appeal & Grievance case inquiries related to customer service complaints.

·         Support department compliance related activities to ensure proper monitoring and controls are in place as required for regulatory compliance audits.

·         Performs other duties as assigned.

Supervisory Responsibilities:

Oversees the Member Experience Department. Carries out managerial responsibilities in accordance with organization policies and applicable laws. Responsibilities; planning, assigning, and directing work; assisting in the rewarding and disciplining of assigned employees; addressing complaints and resolving problems as they pertain to the department.

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

·         Minimum Experience:

o   Minimum five (5) years of Call Center experience required.

o   Minimum three (3) years in management capacity in a compliance-driven industry required; management experience in health plan/Medicare industry highly preferred.

o   Knowledge of Medicare Managed Care Plans required.

·         Education/Licensure:

o   High school diploma or general education degree (GED); and three to five years related experience and/or training; or equivalent combination of education and experience.

o   Bachelor’s degree in healthcare, business, or related field (preferred)

·         Other:

o   Bilingual in English and Spanish highly preferred.

o   Demonstrated knowledge of CMS Call Center Metrics, CAHPS, etc.

o   Excellent communication skills, both written and verbal.

o   Proven record to monitor and motivate employees; including oversight of outsource vendor and/or remote workforce a plus.

o   Demonstrated success with implementation and/or management of applications, such as: workforce management, CRM, campaign manager, EMR PM, etc.

o   Self-starter with strong analytical, critical thinking, problem-solving, leadership, and relationship-building skills.

o   Strong interpersonal skills and a collaborative management style.

o   Language Skills:  Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.

o   Mathematical Skills:  Ability to add and subtract two-digit numbers and to multiply and divide with 10’s and 100’s. Ability to perform these operations using units of American money and weight measurement, volume, and distance.

o   Reasoning Skills:  Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.

o   Advanced computer skills and experience with Microsoft Suite (Word, PowerPoint, Excel, Outlook) required.

o   Other Skills and Abilities:

§  Excellent telephone techniques.

§  Excellent data entry.

§  Strong organizational skills.

§  Type 40+ words per minute.

Experience with 10-key by touch.

·         Work Environment

o   The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

§  The noise level in the work environment is usually moderate.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

·         While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.

·         The employee is frequently required to walk, stand; reach with hands and arms.

·         The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl.

·         The employee must occasionally lift and/or move up to 20 pounds.

·         Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.