Member Services Supervisor (D-SNP) Bilingual / Job Req 805627649 (Manufacturing)

PRINCIPAL RESPONSIBILITIES:
Under the general direction of the Sr. Director Member Services, the Member Services Supervisor D-SNP, is responsible for overseeing the daily operations of a team of call center agents who primarily handle inquiries and coordinate care for Dual Special Needs Plan (D-SNP) members, ensuring quality service delivery while adhering to complex healthcare regulations, monitoring performance metrics, providing coaching, and resolving escalated issues within the D-SNP framework;essentially leading a call center focused on providing specialized care to dual eligible Medicare beneficiaries The position is expected to comply with all Center for Medicare & Medicaid Services (CMS) and State guidelines and quickly report any potential issues to the Sr. Director, Member Services or designee. The Member Services Supervisor, D-SNP may serve as a back-up to the Member Services Supervisor when needed.

Principal responsibilities include:
Leading and motivating a team of call center representatives responsible for managing D-SNP member calls.
Monitoring individual performance against key metrics like call quality, adherence to D-SNP guidelines, and Member satisfaction.
Providing regular feedback and coaching to staff on improving their handling of complex D-SNP member needs.
Addressing performance issues and implementing corrective actions when necessary.
Oversees onboarding, training, coaching, and development of new and existing staff.
Fosters a motivating, supportive team environment.
Developing and managing work schedules to ensure optimal coverage during peak hours and periods of high call volume. Monitoring call center metrics like call abandonment rates, average handle time, and first contact resolution.
Identifying areas for improvement and implementing process changes to optimize efficiency and member experience.
Identifying and addressing staff training needs through perfomance improvement opporutnities to ensure performance metrics are met, maintained or exceeded.
Monitors the call center equipment and ensures functionality.
Monitoring call recordings to ensure agents are adhering to D-SNP policies and procedures, including CMS STAR rating program, CMS secret shopper call monitoring, (Beneficiary hold time; Call Disconnected rate; CSR understandability; Foreign Language Interpreter and TTY availability; Information Accuracy), NCQA Standands, DMHC, DHCS, Knox Keene regulatory requirements.
Auditing member contacts to ensure agents accurately catergorize member inquires, grievances and appeals within regulatory timesframes while providing excellent customer service and resolution.
Creating policies, standard operating procedures (SOPs), productivity standards, roadmaps, reporting, and key performance indicators (KPIs), and performance evaluations in a timely manner.
Conducting quality audits to identify areas for improvement in call handling and member care.
Staying updated on any changes to D-SNP regulations and communicating them effectively to the team.
Resolving concerns and escalating complex cases to appropriate departments when necessary, ensuring clear communication across teams.
Serving as a backup for supervisor(s) virtually or in-person during vacations or other absences to ensure a smooth handover of information, delegation of tasks, and projects, including, but not limited to responding to urgent issues, providing staff oversight and performance feedback, reviewing and approving timesheets, and change requests.

ESSENTIAL FUNCTIONS OF THE JOB:
Maintain compliance with company policies and procedures, including those related to Member service, data privacy, and security.
Identify opportunities to optimize call center processes and procedures, improving efficiency and effectiveness.
Analyze reports on call center performance, identifying areas for improvement and tracking progress towards key performance indicators.
Collaborate with the trainer and QA Manager to develop, create, and implement policies and procedures, (SOPs) workflows and job aids as required to provide training for the D-SNP Member Service Unit.
Participate in the hiring process, onboard new employees, and ensure they are fully trained and equipped to perform their roles.
Conduct 1:1 monthly performance summary review session with staff to provide performance feedback and support.
Conduct side-by-side coachingto agent (s) and coach them before, during, and after a call as part of the agents training.
Create a positive and supportive work environment to boost morale, engagement, and productivity.
Collaborate with other departments to address Member issues, resolve problems, and improve the overall Member experience.
Help members navigate the D-SNP enrollment process and ensure they renew their coverage.
Provide ongoing support to members after they enroll in the plan.
Provide excellent customer service to members and prospective members, answering questions and resolving concerns regarding plan benefits and services.
Ensure that Member Service Navigators provide a high level of customer satisfaction by actively listening to customer needs, responding effectively, and handling complaints professionally.
Educate members about health plan benefits and services.
Collaborate with internal departments to resolve eligibility-related issues
Comply with the organizations Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.
Demonstrate ease working in a fast-paced environment with ability to multi-task and prioritize effectively.
Other duties as assigned.
Monitor call center systems, participate in user acceptance testing (UAT), and maintenance.
Perform all the functions of a Member Services Navigator in times of high call volumes or staff shortage.
Making verbal presentations.
Act as a resource to staff in daily coaching and problem-solving sessions.
Lead and participate in internal and external committees and meetings.
Communicate effectively and efficiently internally and externally.

PHYSICAL REQUIREMENTS:
Constant and close visual work at a desk or a computer.
Constant sitting and working at a desk.
Constant data entry using multiple monitors, keyboard and/or mouse.
Frequent use of telephone headset.
Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
Frequent lifting of files, binders and other objects weighing between 0 and 30 lbs.
Frequent walking and standing.

Number of Employees Direct Supervision: 7-10
Number of Employees In-Direct Supervision: 15-20

MINIMUM QUALIFICATIONS:
EDUCATION OR TRAINING EQUIVALENT TO:

Bachelors degree in healthcare administration or health care related field

Equivalent In lieu of degree: Year over year full time experience may be substituted for the academic major (up to 4 years) when administrative duties are performed in a health service agency or program.

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

2 or more years of experience in the managed care industry with Medicare Advantage/D-SNP related experience.
2 or more years of supervisory work experience in a customer service role, call center environment, or with members facing responsibilities.
Minimum 2 years of experience in a call center environment.
Experience with customer relationship management (CRM) software.

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

The ability to speak and understand-bilingual: Spanish/English, Cantonese/English, Vietnamese/English, Tagalog/English, Arabic/English, and Farsi/English are required as designated.
A bilingual proficiency exam will be administered to ensure the candidate possesses the appropriate skill level to meet requirements. The successful candidate must score 90% or higher.
Experience working in the insurance industry is strongly preferred.
Knowledge of Health Insurance/Medicare strongly preferred.
Strong knowledge of the MOC structured approach to ensure the delivery of coordinated services to meet the needs of the DSNP membership.
Strong understanding of call center metrics and technology
Strong leadership and supervisory experience in a healthcare call center environment.
Comprehensive knowledge of Medicare and D-SNP programs, including eligibility criteria and care coordination guidelines.
Excellent communication and interpersonal skills to effectively handle complex member inquiries and concerns.
Excellent organizational skills with the ability to manage multiple tasks and responsibilities effectively.
Ability to establish rapport with a multi-cultural - diversified population and experience with cultural sensitivity
Proficiency with call center technology and data analysis tools to monitor performance metrics.
Clinical background or understanding of healthcare terminology is preferred.Proficient with Microsoft Office applications, including Word, Excel, Outlook and various database applications.
Detail oriented with problem-solving abilities. Strong and effective verbal and written communication skills to multi- level audiences.
Demonstrates professionalism, poise, tact, and diplomacy in interactions with others.
Demonstrates good judgment, organization and prioritization skills and time management skills.
Proficient conflict management skills with ability to resolve issues during stressful situations.
Basic knowledge of industry regulatory guidelines related to job functionality.
Proven leadership with staff, projects, and management.
Strategic thinking abilities and analytical skills.
Ability to clearly present written information and findings, concisely communicate concepts and make executive-level presentations.
Ability to monitor performance and make real-time decisions.
Experience with call center software and lead management systems.
Ability to maintain confidentiality and ensure Member privacy.

Employees who interact with members of the public may be required to be tested for Tuberculosis and fully vaccinated against COVID-19 and influenza. Successful candidates for those positions/ classifications may be required to submit proof of vaccination against influenza and/or COVID-19, a negative Tuberculosis test, or request an exemption for qualifying medical or religious reasons during the onboarding process. Candidates should not present proof of vaccination until instructed to do so by the Human Resources department.

SALARY RANGE $110,094.40 - $165,131.20 ANNUALLY

The Alliance is an equal opportunity employer and makes all employment decisions on the basis of merit and business necessity. We strive to have the best-qualified person in every job. The Alliance prohibits unlawful discrimination against any employee or applicant for employment based on race, color, religious creed, sex, gender, transgender status, age, sexual orientation, national origin, ethnicity, citizenship, ancestry, religion, marital status, familial status, status as a victim of domestic violence, assault or stalking, military service/veteran status, physical or mental disability, genetic information, medical condition, employees requesting accommodation of a disability or religious belief, political affiliation or activities, or any other status protected by federal, state, or local laws.