Member services team lead

Description

SCOPE OF POSITION: The Team Lead provides day-to-day operational leadership and support for Member Services inbound and outbound operations. This position serves as a liaison between frontline representatives and supervisory leadership and provides operational coverage in the absence of the assigned supervisor. The Team Lead supports daily workflow, employee guidance, escalated member issues, performance monitoring, project coordination, training, quality, and achievement of departmental and contractual performance expectations. Support the organization’s mission, vision, and values by exhibiting the following behaviors: Honesty, Excellence Accountability, Respect, and Teamwork.

ESSENTIAL JOB FUNCTIONS:

• Assist with identifying, researching, correcting, and linking or unlinking incorrect beneficiary records within MMIS.
• Serve as subject matter expert and trainer for MMIS within the Beneficiary Relations department.
• Maintain comprehensive knowledge of specialty areas, pertinent organizations, and health care environment. Knowledge should include information regarding contract, contract deliverables, policies and procedures, resources available, current research and reports, trends, etc.
• Responsible for the resolution of customer/client requests including research, referral, policy review, revision and development, documentation and follow up in accordance with established policy/procedures.
• Communicate effectively with customers and/or recipients.
• Develop and maintain working relationships as necessary to meet contract deliverables of specialty area project.
• Function as a resource to internal and external customers for information pertaining to specialty area focus.
• Understand and utilize project-tracking database to document and monitor services/activities provided and to compile a comprehensive database of activity.
• Maintain accurate statistical data to meet contractual and other reporting requirements.
• Coordinate the timely collection and data entry of all required documentation.
• Work with Information Services department to coordinate system developments and customizations.
• Assist in the creation and maintenance of necessary reports/documents to track and report project information.
• Prepare ad hoc reports and/or statistics as directed.
• Monitor specific items within the area of focus, provide recommendations/feedback to external customers for quality improvement, and follow through for compliance with recommendations for improvement.
• Training and knowledge in all other areas of Beneficiary Relations to assist as needed with the overall operation of the Beneficiary Relations department.
• Assist in the development, production, maintenance, and delivery of educational materials/activities.
• Daily quotas may be added to meet contract deliverables as needed.
• Adhere to format, content, and style guidelines, considering usability and ensuring accuracy, consistency, and quality.
• Communicate needs and requests to other team members as appropriate, as well as management.
• Follow AFMC, state and federal protocols regarding data confidentiality/security and HIPAA compliance.
• Serve as the designated point of contact and provide operational coverage when the supervisor is unavailable.
• Assist with daily workflow management, escalations, staffing concerns, and operational decisions within established authority.
• Escalate employee relations, disciplinary, or other management-level matters to the appropriate supervisor or manager.
• Provide real-time guidance and support to Member Services representatives regarding policies, procedures, systems, and complex member inquiries.
• Serve as the first level of escalation for difficult or complex member/customer interactions.
• Assist agents with resolving issues while promoting first-contact resolution and a positive member experience.
• Monitor daily staffing, attendance, schedule adherence, breaks, lunches, and employee availability and communicate concerns to the supervisor.
• Assist with coordinating daily coverage based on operational needs.
• Additional duties as assigned.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Must possess intermediate level computer skills (Excel, Word, Power Point and Outlook).
• Type 25 wpm.
• Exceptional skills in business English and spelling.
• Ability to maintain confidentiality.
• Strong oral and written communication skills.
• Creativity.
• Customer service.
• Ability to meet deadlines.
• Attention to detail.
• Flexibility.
• Knowledge of HIT/EHR.
• Medical terminology.
• Ability to work collaboratively and independently to achieve stated goals.
• Initiative.
• Ability to relate professionally and positively with staff, business partners, customers, constituents, beneficiaries, and the public.
• Ability to multitask.
• Ability to prioritize.
• Strong organizational skills.
• Problem solving skills.
• Professionalism.
• Project management skills.
• Ability to read, interpret and apply laws, rules, and regulations.
• Knowledge of quality improvement processes and techniques.
• Time management skills.
• Strong leadership skills.
• Ability to work overtime as needed.

Requirements

Physical and Sensory Requirements (With or Without the Aid of Mechanical Devices): Mobility, reaching, bending, lifting, grasping, ability to read and write, ability to communicate with personnel, ability to remain calm under stress. Must be capable of performing the essential job functions of this job, with or without reasonable accommodation.

EDUCATION: High School Diploma

EXPERIENCE: Three (3) to four (4) years’ experience within customer relations, and thorough understanding of the Medicaid Guidelines. Desirable: Three (3) to four (4) years’ experience within the healthcare arena. One (1) year leadership experience.

INTERNET REQUIREMENTS: Reliable, high-speed wireless internet service (Wi-Fi) An upload speed of at least 5Mbps is required to support softphone functionality.