PRINCIPAL RESPONSIBILITIES: Under general direction from the Sr. Manager, Member Services, the Member Services Outbound Supervisor is responsible for the day-to-day supervision of Member Services Outbound Representatives, collaborating with other department Supervisors and other department leadership members to meet and exceed performance targets. The Member Service Outbound Supervisor will primarily oversee Member Services Outbound Representative Tier I and Member Services Outbound Representative Tier II.

The Member Services Outbound Supervisor is responsible for ensuring member concerns are processed in a timely and accurate manner by communicating and enforcing department goals and objectives within a total quality management approach and compliance with all applicable state/federal regulations. The Member Services Outbound Supervisor will be responsible for the quality of the member services representatives daily work and activities, including but not limited to monitoring, developing, implementing, and evaluating the departmental call center operations to ensure optimal proficiency and effectiveness. The Supervisor will oversee assigned production and workflow systems, monitor, and enforce production and quality standards, ensure compliance with all operating policies and procedures, and collaborate with other departments to ensure the Alliances business, operating, and reporting goals are met. The Supervisor may occasionally function as a Member Service Representative in high call volumes or staffing shortages.

PRINCIPAL RESPONSIBILITIES INCLUDE:

Supervise the daily operations of Call Center staff to ensure appropriate usage of resources to facilitate the Call Center process.

Identifying the training needs includes assisting in the development of programs, training materials, job aids, orientation checklists, and competency checklists necessary to meet the educational and training needs of departmental staff.

Developing tools and workflows to assist in the training and development of staff.

Responsible for maintaining any training materials to align with the current process to provide accurate and consistent plan benefit and service information to our members to meet regulatory requirements.

Develop and conduct team training and education courses, including management education and training for new employees, ongoing staff, and cross-training of staff as needed.

Develop and maintain complex audit processes and audit tools related to grievances, quality, compliance, and accurate data entry.

Train staff to use audit tools and identify patterns or trends that require additional training or corrective action.

Educate staff as necessary to ensure consistent performance and adherence to standards.

Audit staff in accordance with established auditing processes, work with the team to identify and resolve errors in data and reporting, and present findings and recommendations for improvement to management.

Coach and train staff to identify the potential quality of care/service and accessibility concerns and refer to Grievance and Appeals (GandA) or Quality Improvement (QI).

Identify opportunities for process improvements to facilitate department functions and ensure compliance with applicable governmental program guidelines.

Provide leadership while serving as a subject matter expert for Member Services and acts as a resource for AAH and community partners.

Identify system issues that fail to provide appropriate service to members or meet service expectations and make recommendations for improvement.

Evaluate policies and procedures and analyze/recommend enhancements to ensure adherence to regulatory requirements.

Assist with ensuring consistent data collection from MS staff that is used to assist the company in achieving strategic goals, to improve monitoring and reporting in order to meet external requirements.

Assist in writing and implementing business requirements for any software systems used by the call center to assist external and internal customers including but not limited to Healthsuite; QualitySuite; CiscoFinesse; TruCare; Darwin; PerformPA; Calabrio; Hanna/Cyracom- Interpreter Services appointment Scheduler; delegate portals, etc.

Maintain and report records of training activities and employee monthly performance reports to MS Leadership.

Assist with revisions to policies and procedures and work process development.

Work closely with all levels of call center leadership regarding daily operations.

Prepare for and participate in regulatory audits and develop and monitor corrective actions plans.

Manage and prioritize workload while meeting deliverables and expectations.

Maintain working knowledge of regulatory requirements for DHCS