The Member Services Supervisor is responsible for ensuring the delivery of outstanding customer service resolving issues and delivering accurate information to BMCHP members and providers.  The Member Services Supervisor is responsible for participating in the recommendation, development and implementation of short and long-term quality service strategies that improve member and provider satisfaction and Customer Care and CRU operations.  The Member Services Supervisor will have a primary focus on Member Services for the NH Medicaid population.  

The Member Services Supervisor is responsible for the direct supervision of Customer Care Center and Provider Services staff and ensures that all necessary tools and resources are available to meet or exceed state contractual requirements and corporate standards servicing members and providers across product lines.  The Member Services Supervisor is also responsible for proactively and methodically identifying and resolving service barriers (including but not limited to claims, eligibility, enrollment, prior authorization and benefits) and working with partner departments as needed.   

The Member Services Supervisor works in close collaboration with the Customer care management team to ensure that Member Services provides members and providers with the highest levels of customer service, meets applicable requirements and standards and strives for continuous improvement.

Key Functions/Responsibilities:

General

• Implements Customer Care department policies, procedures and standards, and supervises NH Member Services telephonic and office operations to achieve productivity targets, quality standards and operational goals.
• Participates in the development of policies and procedures to ensure outstanding service delivery and member and provider satisfaction.
• Responsible for the daily analysis of call volumes, monitoring and adjusting staff resources (scheduling) to meet inbound demands (provider) and performance goals and maximize efficiency.
• Ensures monthly compliance with corporate standards.
• Establishes, maintains and refines intradepartmental and interdepartmental processes and procedures to support Member Services work processes across product lines.
• Monitors staff to ensure compliance with established workflows.
• Resolves first line policy questions referred by staff and works with partner supervisors and managers as needed to resolve. 
• Ensures Member Services staff has the technology and training needed to provide outstanding customer service.
• Works closely with the Customer Care Analyst to identify reporting and metrics needed to ensure appropriate staffing levels, improve service delivery, maximize efficiency and increase cost effectiveness.
• Works closely with the Customer Care Analyst to identify and implement technological enhancements to improve service delivery.
• Works in close collaboration with the Trainer to identify training opportunities (and optimum delivery method) to enhance customer service through the use of metrics and staff feedback.  Trains or oversees training of staff.
• Works as a member of the Customer Care management team to ensure appropriate work allocation and adherence to all state requirements by sharing resources when necessary.
• Assists and participates as needed in budget planning. 
• Contributes to development and maintenance of member and provider materials.

Provider Services

• Works collaboratively with partner departments, including but not limited to, Claims, Provider Appeals, Contracting, Prior Auth and Provider Relations to provide seamless customer service to providers.
• Works collaboratively with partner departments, including but not limited to Enrollment, Appeals and Grievances and Marketing to provide seamless customer service to members.
• Monitors call trends to proactively identify existing and potential member and provider service issues.
• Communicates and escalates provider issues as needed in real time to appropriate partner departments and/or senior management.

Performance Management and Staff Development

• Supervises CCC Representatives to ensure productivity and quality through consistent application of Performance Management Program.
• Serves as back-up/covering as needed for supervision/support of Provider Services Representatives.
• Responsible for performance appraisals of all direct reports.
• Meets weekly with team to identify service challenges and barriers.
• Works in close collaboration with the Trainer in the development and delivery of training programs to foster professional development of staff.

Other

• Maintains current knowledge of Well Sense and payment and reimbursement policies, member coverage and benefits, and claims adjudication rules.
• Maintains current knowledge of Well Sense benefits, provider network development and contract issues, NH Medicaid regulations, state and Well Sense payment and reimbursement policies and industry standards for claims processing issues. 
• Maintains current knowledge of FACETS Customer Service Module, AVAYA, CCMS, and all systems used by Customer Care staff and management.  
• Leads project activities including assigning tasks, determining project schedule and resolving project issues.
• Represents department on cross-functional initiatives.
• Performs other tasks as needed as a member of the Customer Care management team to meet the goals of Customer Care and Well Sense.

Supervision Exercised:

• Supervises 5-15 staff.

Education:

• Bachelor’s degree or an equivalent combination of education, training and experience is required.

Experience:

• Three or more years call center experience required.
• Three or more years experience in Medicaid and/or Medicare healthcare or managed care is required.

Preferred/Desirable:

• Three or more years of supervisory experience preferred.

Competencies, Skills, and Attributes:  

• Demonstrates exceptional critical thinking and analytical skills.
• Understands cause and effect and possesses strong problem-solving skills.
• Strong oral and written communication skills and ability to interact within all levels of the organization.
• Effective collaborative and proven process improvement skills.
• A strong working knowledge of Microsoft Office products.
• Demonstrated ability to successfully plan, organize and manage projects.
• Detail oriented, excellent proof reading and editing skills.

Working Conditions and Physical Effort:

• Work is usually performed in a call center environment.
• Regular and reliable attendance is an essential function of the position.
• Work is normally performed in a typical interior/office work environment.
• No or very limited physical effort required. No or very limited exposure to physical risk.