Team Leader Member Relations

Why Choose Jefferson Health Plans?

We are an award-winning, not-for-profit health maintenance organization offering Medicaid, Medicare, and Children's Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We are committed to creating a community where everyone belongs, acknowledges, and celebrates diversity and has opportunities to grow to their fullest potential.

While this job currently provides a flexible remote option, due to in-office meetings, training as required, or other business needs, our employees are to be residents of PA or the nearby states of DE or NJ.

Perks of JHP and why you will love it here:

• Competitive Compensation Packages, including 401(k) Savings Plan with Company Match and Profit Sharing

• Flextime and Work-at-Home Options

• Benefits & Wellness Program including generous Time Off

• Impact on the communities we service

We are seeking a talented and enthusiastic Team Leader, Member Relations to join our team!

General Description:

This position reports to the Member Relations Manager. The team leader works with minimal direction in coordination with the Member Relations Supervisor and Management. Responsibilities include but are not limited to responding to complex external and internal inquiries in a professional, informative, and courteous manner (10-15% on the phone). This role requires mastering and demonstrating skills and concepts within the call center environment. Demonstrates the ability to think outside of the box to identify, resolve, and assist the team with the handling of complex inquiries. Support and represent the Member Relations team. Assist in formulating department guidelines, coordinate projects and assist with staff training when needed.

As the Team Leader, Member Relations, your daily duties may include:

• Directs staff in performance according to standards of practice, state and federal regulations, accreditation agencies and company policies and procedures.

• Serves as the point person/technical resource for issues regarding all lines of business.

• Anticipate and identify causes of interruption in unit functions and takes appropriate action to meet performance expectations.

• Develop, among staff, a consciousness for the need for teamwork to attain departmental objectives. As well as direct staff in a constructive and positive manner to foster positive employee relationships.

• Recommend candidates for hire to the Manager based on subjective and objective findings identified by using a standardized interviewing tool.

• Ensures that reports are completed, accurate, and timely to meet regulatory and company regulations.

• Attend and assume a leadership role in Team meetings, staff meetings, and all external cross-functional meetings.

• Attends external meetings as representative of Health Partners Plans and represent department at meetings which have an impact on Call Center operations and reports on the same.

• Assist Member Relations Representative with accurate benefit information for callers.

• Assist in the coordination of special assignments including reports and departmental projects.

• Provide phone coverage on high call volume days to provide telephone support as required and handle calls which escalate beyond the Member Relations Representatives abilities.

• Act as a liaison to member's who request one-on-one assistance.

• Provide Floor Support.

• Member Relations Macess Inventory Oversight.

• Responsible for the documentation of operating procedures.

• Collaborate with leadership and support team to set up touch point meetings with an agenda. Provide recommendations and feedback based off team performance.

• Tracking/Trending of call volumes and escalated matters, reporting on trends and issues that impact the Member Relations Department.

• Coordinate cross-functional and interdepartmental initiatives.

• Schedule and assist with the facilitation of team meetings, and huddles.

• Adhere to the following turn-around times for issue resolutions via e-mail, Macess, in-person, etc.

• Follow Department guidelines on response time and resolution (acknowledgement) for standard inquiries and, expedited issues.

• Evaluate staff quality performance utilizing coaching tools as a resource for improvement.

• Mentoring staff using intense one on one coaching sessions as a means of performance enhancement.

• Facilitate mini group and individual training sessions to support staff with knowledge gaps to perform across functional discipline.

• Review staff's monthly audit appeals for accuracy and appropriateness of submission.

• Provide supervision and support to Call Center staff, including participating in the monthly.

• On Call rotation cycles which provides 24/7 support.

• Attend SQC and Fair Hearing meetings to provide interpretation and feedback as needed.

• Other duties as assigned.

Qualifications

• High School Diploma or equivalent work experience.
• 3-5 years progressive customer service experience across multiple disciplines preferred.

Skills, We Value:

• Excellent written and verbal communications skills.

• Bilingual a plus, but not necessary.

• Ability to work independent of direct supervision, but also must be able to work within a team.

• Proficiency in Departmental Information Systems including DPW, Member Health Information System and Pharmacy Systems.

Other details

• Pay Type Salary

Apply Now

• Philadelphia, PA, USA