Job Description

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

* Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women

* Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

* Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.

* Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

Skills / Requirements

JOB SUMMARY:
Experienced in a Health Care / Plan Customer Service Center professional. Individual should possess extensive knowledge of health insurance. Experience in working on projects; assisting staff, ad hoc support to other areas as needed. Exhibits leadership qualities.

Customer Service Supervisor:
The Customer Service Center Supervisor will provide direct oversight of the Customer Service Center Representatives as they answer questions and handle complaints of customers to ensure that department performance requirements are met. They will coordinate with the Customer Service Center Coaches to develop and foster a highly effective team, ensuring that established goals and standards are met, manages daily workload to uphold productivity levels, quality outcomes, performance guarantees, timeliness, and customer satisfaction metrics. Works with other departments to address complex issues for an appropriate resolution. Assist in process improvement initiatives.

Engagement Supervisor:
The Customer Engagement Supervisor will be responsible for managing the communication and employees that support our Members via an Outbound call. The Customer Engagement Supervisor will collaborate with the Customer Service Leadership Teams to identify outreach initiatives and opportunities, deliver positive change and business efficiencies, highlight operation risk and areas for improvement, and monitoring productivity. The Customer Engagement Supervisor will create and execute project plans, revising them as appropriate to meet changing needs ensuring completion of projects on time.

Quality Supervisor: 
The Quality Supervisor will be responsible for the day-to-day performance of a team of Call Quality Assurance Analyst in meeting/exceeding requirements through continuous improvement. The Service Quality Supervisor will be responsible for coordinating the timely completion of Member Services call quality audits, reporting findings at the agent, team, and departmental level for all lines of business. The Service Quality Supervisor will partner with training to identify training needs and lead monthly calibration sessions. The Service Quality Supervisor will assist in the development of a strategy to execute areas of deficiency and turnaround times for correction. The Service Quality Supervisor will complete quality review audits for all analysts to ensure that calls are being reviewed and scored according to quality guidelines. The Service Quality supervisor will be responsible for the specifications of Speech Analytics to ensure that accurate data mining is completed, and the Voice of the Customer (VoC) is trended for continued improvement within the call center. The Call Quality Assurance Supervisor will be responsible for maintaining the design and updates to the Call Quality Assurance Monitoring Evaluation form to include software selection, loading of the evaluation, weights per category, deployment of software, and remaining abreast of new technology to implement within the call center.

Fulfillment Supervisor:
The Fulfillment Supervisor will be responsible for the operational aspects of the Fulfillment team, to include mail processing, email processing, facsimile processing, coordination of member materials, inventory management and processing of member requests. The Fulfillment Supervisor is responsible for vendor relations and management, auditing fulfillment transactions, workflow management, coordinating the resolution of complex customer issues, and handling escalations.

MINIMUM QUALIFICATIONS:
1. Education/Specialized Training/Licensure: High School Diploma or GED required. Associates degree preferred.
2. Work Experience (Years and Area):  Three years of experience with health insurance, managed care, or other related experience required.  Preferred knowledge of Contact Center operations.
3. Management Experience (Years and Area): Experience in working on projects; assisting other reps, ad hoc support to other areas as needed is required. Exhibits leadership qualities.  Preferred knowledge of Contact Center operations.
4. Software Proficiencies:  Microsoft Word/Excel/PowerPoint required.

JOB SPECIFICATIONS AND CORE COMPETENCIES:
Customer Service Supervisor:
Essential Functions
Exhibits leadership qualities.
Assisting Staff
Projects
Marginal Functions
Ad hoc support to other areas as needed.

Engagement Supervisor:
Essential Functions
Manage the Outbound Call Project from the beginning to the end in addition to the Outbound Member Services Teams performance on the Outbound Calls.
Assisting Staff
Projects
Marginal Functions
Ad hoc support to other areas as needed.

Quality Supervisor:
Essential Functions
Performance Management
Responsible for compiling productivity for staff members and sending monthly reports to the Customer Service Manager
Responsible for updating and managing scorecards for the staff.
Responsible for staying abreast of staffing levels and assigns agents to a Performance Improvement Specialist, Service Quality Coordinator, and or Enrollment QA Analyst for a specified time frame. Updates staff on additions or removals from their rosters
Responsible for communicating job expectations and conducts annual performance reviews.
Responsible for administering corrective action for staff failing to meet performance expectations.

1:1s and Team Huddles
Responsible for facilitating huddles with the staff regularly to provide departmental updates or changes.
Responsible for providing timely feedback to staff on performance and other areas of measurement.

Staff Observations/Audits
Responsible for observing staff to ensure compliance with processes and workflows.
Responsible for auditing quality evaluation forms, coaching plans, calibration summaries, and other documents as needed.

Call Calibrations
Schedule and lead Call Quality Assurance Monitoring Calibration sessions with Service Quality Coordinators and Lines of Business as needed.
Identify areas of opportunities due to variances in grading by Service Quality Coordinators and other stakeholders
Track and report calibration sessions to determine trends and variances in grading. Report findings to the Customer Service Manager and other Department Leaders

Nesting
Responsible for creating Nesting calendar and assigning Performance Improvement Specialists to provide support during those dates.
Responsible for compiling observations from Performance Improvement Specialists and reporting to Leadership of the Lines of Business
Assigns new agents in nesting to a Performance Improvement Specialist and Service Quality Coordinator for auditing and coaching purposes.

Marginal Functions
Interviewing and Hiring New Staff
Updating QA Forms/Guides
Other Similar/related duties as assigned per the business needs.

Fulfillment Supervisor:
Essential Functions
Establish time-to-completion for all intake and outgoing items, to include documentation of receipt, routing, and response.
Track / trend / report on total items received, completion time, delays, and escalations.
Partner with IT to create streamlined workflows and develop auto responses to prevent duplicate requests.

Marginal Functions
Set and lead monthly meeting to identify and resolve escalated issues.
Responsible for records retention policy and associated activities
 

Application Instructions

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