CHRISTUS System Office
CHRISTUS Corp Health Plan 919 and 909 Buildings
919 Hidden Ridge
Irving, TX 75038
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Under the supervision of the Member Services Department Manager, this position is responsible for the delivery of superior customer service by ensuring calls are answered efficiently and effectively throughout the day. Responsible for recruiting, hiring, training, coaching, and mentoring representatives and conducting meaningful performance reviews. Resolving escalated calls, dispatching supervisory calls, and assisting Member Services Representative with any client related questions. Works with other departments to confirm that member needs are being met and determines trends in member issues. Oversees the receipt of requests for information, and complaints from members to identify additional training opportunities. Monitors call volume and department staffing to ensure all Service Level Agreements (SLAs) are within acceptable compliance levels per state and federal regulations. Monitor Member Services Representatives on calls to verify timely, accurate, and complete responses. Participate in improvement initiatives to increase overall call handling efficiency within the department. Additional responsibilities to include balancing workloads, assisting with establishment of structure and standardization, creation and updating of departmental policies and process and implementation and maintenance of oversight within the Member Services Department.
- Member Services hiring, training and development
- KRONOS time tracking
- Success Factors: Employee goal-setting, routine rating
- Overall employee development
- Conducts Call Quality Audits
- Identify prevalent trends and recommend resolution techniques to management
- Delegates work to Member Service staff as needed
- Monitors call traffic and makes adjustments based on call center traffic patterns.
- Assists with system emergencies with direction from IT department and/or appropriate vendor
- Assignment of Member Services tasks
- Assists in disseminating information to staff as needed
- Performs other related duties and special projects as requested
- All other duties assigned by management
- Collaborate with and maintain open communication with all departments within CHRISTUS Health to ensure effective and efficient workflow and facilitate completion of tasks/goals
- Follow the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)
- Analytic ability to organize and prioritize work to meet deadlines
- Ability to organize and prioritize work to meet deadlines
- Strong computer application skills including Microsoft Word, Excel and Visio
- Excellent written and verbal communication skills required
- Good judgment, initiative and problem solving abilities
- Ability to handle and resolve complex issues independently
- Knowledge of Medicaid, Medicare Advantage, Tricare and Health Care Exchange programs preferred
- Knowledge of claims processing, system configuration, edits, adjustment adjudication and claim department processes
- Ability to learn new policies and processes based on written material and observation
- Ability to establish and maintain professional, positive and effective work relationships
- 2 years Healthcare experience with Managed Care experience required
- Prior Call Center Experience is highly preferred.
- Prior Member Service team management experience preferred
- Experience in Avaya CMS Supervisor is highly preferred.
- Prior experience working with TRICARE, Texas Medicaid, Medicare Advantage highly desirable.
- Driver's License