Summary
Supervises and coordinates the activities of the Customer Service Representative and Technician Functions engaged in responding to routine and highly technical claim, benefit and investigation inquiries.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
· Ensures a high level of customer service by actively managing daily call volumes and promoting the availability of the customer service staff for member and provider calls.
· Works closely with the Quality Audit team to ensure that monitoring results are completed on a weekly basis. Actively participates in the monitoring program to observe employee demeanor, technical accuracy and conformity to company policies.
· Analyzes and manages the receipts and releases of routine and technical inquiries while ensuring accurate, thorough and timely responses.
· Maintains an open inquiry aging inventory on a weekly basis within the established goals for the BCS department.
· Answers questions and recommends corrective action to address and diffuse customer grievances.
· Studies and standardizes procedures to improve efficiency of subordinates.
· Works closely with the training department to establish training objectives that promote initial and continued development of customer service soft and technical skills of the customer service representatives.
· Advocate of Resource Balance (RB) activity. Works closely with the WFM team to ensure that resources are balanced between phone service and RB objectives.
· Demonstrates an understanding of claim investigation and claim appeal inquiries. Teaches subordinates about HSC Underwriting and RMC processes.
· Leads and participates in special projects as assigned.
· Experience with Supervising high volume call center (100 or more employees).
Supervisory Responsibilities
· Demonstrates advanced leadership abilities within the supervisor team. Is known for their ability to achieve goals independent of management supervision. Is a visible supervisor managing and assessing performance by walking around and motivating employees.
· Actively seeks parity across the units to achieve a consistent and cohesive approach to managing employees.
· Acts as a change agent actively supporting the future vision of HSC and implements department strategies in support of the future direction of Hallmark. Maintains a high level of optimism during times of change and adversity.
· Works closely with the WFM team to ensure that representatives are following work schedules according to the department standards set for production, make busy and open time, and schedule adherence.
· Interviews and hires employees whose education and experience best match the required rep skill set. Identifies reasons for attrition and responds appropriately to help improve future attrition rates.
· Motivates employees by promoting a high level of morale and encourages employees to recognize their individual excellence.
· Independently engages employees through informal and formal coaching opportunities. Prepares and conducts annual and 90-day performances reviews. Provides additional performance feedback throughout the year by issuing weekly production and monitoring statistics and conducting bimonthly discussions. Is always available to staff members and welcomes feedback.
· Promotes a professional work environment and resolves employee grievances.
· Ensures conformance to the policies cited in the "Policy and Practice Handbook".
· Administers fair and equitable treatment when addressing employee performance and conduct issues.
· Is a model for the HSC and HCSC “Code of Conduct and Business Ethics” handbooks.
· Is comfortable conducting formal and informal presentations to internal and external constituents.
Competencies
To perform the job successfully, an individual should demonstrate the following competencies:
Analytical - Synthesizes complex or diverse information; Collects and researches data; Designs work flows and procedures.
Design - Generates creative solutions; Uses feedback to modify designs; Applies design principles; Demonstrates attention to detail.
Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
Project Management - Communicates changes and progress; Completes projects on time and budget.
Technical Skills - Assesses own strengths and weaknesses; Pursues training and development opportunities; Strives to continuously build knowledge and skills; Shares expertise with others.
Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.
Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.
Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.
Visionary Leadership - Displays passion and optimism; Inspires respect and trust; Mobilizes others to fulfill the vision.
Change Management - Communicates changes effectively; Builds commitment and overcomes resistance; Prepares and supports those affected by change; Monitors transition and evaluates results.
Delegation - Delegates work assignments; Matches the responsibility to the person; Gives authority to work independently; Sets expectations and monitors delegated activities; Provides recognition for results.
Leadership - Exhibits confidence in self and others; Inspires and motivates others to perform well; Effectively influences actions and opinions of others; Accepts feedback from others; Gives appropriate recognition to others.
Managing People - Includes staff in planning, decision-making, facilitating and process improvement; Takes responsibility for subordinates' activities; Makes self available to staff; Provides regular performance feedback; Develops subordinates' skills and encourages growth; Solicits and applies customer feedback (internal and external); Fosters quality focus in others; Improves processes, products and services.; Continually works to improve supervisory skills.
Quality Management - Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.
Business Acumen - Understands business implications of decisions; Displays orientation to profitability; Demonstrates knowledge of market and competition; Aligns work with strategic goals.
Cost Consciousness - Conserves organizational resources.
Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce.
Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.
Organizational Support - Follows policies and procedures; Completes administrative tasks correctly and on time; Supports organization's goals and values; Benefits organization through outside activities; Supports affirmative action and respects diversity.
Strategic Thinking - Understands organization's strengths & weaknesses.
Judgment - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.
Motivation - Sets and achieves challenging goals; Demonstrates persistence and overcomes obstacles; Measures self against standard of excellence.
Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives; Organizes or schedules other people and their tasks; Develops realistic action plans.
Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly.
Safety and Security - Determines appropriate action beyond guidelines; Reports potentially unsafe conditions .
Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.
Attendance/Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.
Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.
Initiative - Volunteers readily; Undertakes self-development activities; Seeks increased responsibilities; Asks for and offers help when needed.
Innovation - Displays original thinking and creativity; Generates suggestions for improving work; Develops innovative approaches and ideas; Presents ideas and information in a manner that gets others' attention.
Qualifications 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.
Education and/or Experience
Bachelor's degree (B. A.) from four-year College or university; or related professional experience and/or training; or equivalent combination of education and experience.
Language Skills
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
Mathematical Skills
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Reasoning Ability
Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
Physical Demands 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 and talk or hear. The employee is frequently required to stand and walk. Specific vision abilities required by this job include close vision, distance vision, depth perception and ability to adjust focus.
Work Environment 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.