This position is responsible for support customers and team members while working in a fast-paced environment using several modes of communication including face-to-face, video conferencing, telephone, chat, messaging, and email. Serving as a resource for the team, the lead will take escalated or difficult calls and provide direct customer support needed.
A lead must have excellent interpersonal skills to understand customer inquiries or complaints and manage difficult conversations. Leads will act as the voice of the customer, advocating on their behalf to ensure they receive best in class service by proactively identifying and escalating priority issues, de-escalating when appropriate, and going above and beyond to meet customer needs. Leads will take lessons learned to inform process improvement and workflow changes. They must be able to learn quickly so they can acquire the service and product knowledge to answer customers’ questions accurately. Their work must be concise and accurate. They must have a good knowledge of telephone and computer systems. The lead makes no medical necessity decisions.
The teams of the Engagement Center are an essential part of the Health Care Team, so patients can receive accessible and cost-effective care. To be successful, Leads must be proficient in maintaining relationships with a variety of stakeholders and serve as role model for the team through upstanding behavior and professionalism. Leads will be privy to confidential information and must always utilize discretion and maintain position scope. They will frequently move between various levels of work and will need to be agile and adaptable. While leads act as mentors and provide a degree of informal leadership and support to supervisors, they are not in a formal leadership role and do not have direct reports.
The Engagement Center operates 24x7x365. Leads must be willing to work at the times needed to provide service to meet customer needs. Some positions include evening, night, weekend, and holiday hours.
Incumbent will provide a variety of services. These can include, but are not limited to:
• Role model of professionalism and supports a culture of patient centeredness and just culture, “see something, say something”.
• Provides support to team members as necessary to assist with education, training, escalated calls, and feedback to support process health and development.
• Identify areas of opportunity and perform root cause analysis for process improvement.
• Keep up-to-date on processes and business changes.
• Build and maintain team knowledge base systems including creating and maintaining standard work and process flows.
• Act as a subject matter expert in technical upgrades and advances to test and improve the product or process.
• Use critical thinking to remove barriers to maintain productivity and creative solutions when established policies and procedures fail to ensure customer satisfaction.
• Acts as key connecting point between team, Engagement Center leaders, as well as external departments to aid in issue resolution and process improvement.
• Follow established standard policies and procedures to complete pertinent tasks, accurate information intake/documentation and analysis meet customer needs, and work for one call resolution.
• Utilize conflict resolution skills as applicable; demonstrate effective listening skills and patience.
• Successfully complete special projects as assigned.
• Support team in answering and routing of high volume of inbound/outbound interactions through multiple channels and computer software systems. Assist with answering customers’ requests as needed based on complexity of situation or volume. Communicating with customers to resolve inquiries using various platforms.
• Coordinating healthcare services including appointment scheduling (of all complexities), updating patient records, obtaining authorizations, communicating with care teams, arranging transportation, paging on-call physicians, escalating patient concerns, general compliant and grievance resolution, basic navigation of the healthcare system, providing technical support, and payment collection.
• Provide appropriate responses to customers regarding health plan benefits to include, but not limited to eligibility, benefit quoting, provider network, referral, and authorization process, claims payment, as well as policies and procedures.
• Handle inquiries related to compliance and regulatory auditing. Able to work through and resolve complex claims and payment processes.
• Perform service recovery to retain positive customer relationships and utilization of the health system to retain and promote customer loyalty.
Performs other duties as required as well to meet and exceed performance goals to ensure all departmental & organizational goals are achieved.