Senior Manager, Customer Solution Call Center

Job Summary

The Senior Manager of Customer Solution Center (CSC) Call Center will have direct oversight and accountability of multiple member, provider, and lead generation call center units across all product lines. This position will work in close partnership with product leadership and compliance to collaborate and execute programs, initiatives, and the implementation of new regulatory requirements. The Senior Manager is accountable for managing change at all levels within each vertical by collaborating with internal stakeholders, planning, coordinating, facilitating, and directing their respective call center units. The Senior Manager will have a keen focus on continuous quality improvement; Ensuring compliance with applicable internal policies and procedures and external State and Federal regulations for multiple product lines; Oversight of product and regulatory Key Performance Indicators (KPIs) of assigned call center units; making recommendations and optimizing usage of call center resources, and ensuring frontline leaders are focused on real-time and intra-day performance.; Ensuring call center units are compliant with contractual and regulatory entities such a Centers for Medicare and Medicaid Services (CMS), California Department of Health Care Services (DHCS), California Department of Managed Health Care (DMHC) and Covered California by recommending and appropriately implementing and/or facilitating process and system enhancements; Overseeing the development and/or update of related departmental policies, procedures, process flows, etc.

The Senior Manager will support the Director and partner with Workforce Management on continuous optimization of the staffing strategy in an effort to provide an optimal member and provider customer service experience. The Senior Manager is responsible for taking lead and effectively representing the department and the organization in internal and regulatory audits, initiatives, as well as facilitating and/or providing technical expertise and support for various cross-functional meetings, task forces, and committees. The Senior Manager will be directly responsible for identification of areas of improvement within their call center units to help improve the member experience and increase positive audit outcomes, and will partner with the Call Center Director to drive execution on strategic initiatives. Manages and provides technical leadership and supervision to all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.

Duties

Ensures call center compliance with applicable internal policies and procedures and external State and Federal regulations for multiple product lines (Medicaid, Medicare and Commercial).

Prepares materials for all audits (internal, external, mock, or regulatory) and leads audit/post-audit activities. Designs and executes audit related corrective action plans and ensures deficiencies are corrected.

Designs and implements programs, policies, and practices to be fully compliant with state and federal contracts, as well as legal and regulatory requirements.

Ensures ongoing compliance readiness by conducting internal risk assessments and partnering with the training department to provide staff education and training on compliance-related requirements, and investigating/reporting suspected cases of non-compliance.

Manages multiple call center units by providing guidance to frontline leaders, monitoring product specific performance and trends, identifying process improvement opportunities and driving change for positive member experience outcomes while maintaining regulatory standards.

Encourages frontline leaders to provide recommendations for relevant process and systems enhancements. Drives strategic initiatives in collaboration with product leaders and internal/external customers.

Collaborates with senior leadership and customer experience committees to develop and implement strategies for continuous improvement.

Partners with Workforce Management and leads planning and execution of staffing strategies for assigned call center units.

Conducts ongoing evaluation of operations, process improvement opportunities, and outcomes. Ongoing review and analysis of call driver trends, common issues that require individual or group retraining, recommendations for increased efficiency, and ensuring performance is measured against key elements identified by product and/ or regulatory requirements in order to proactively remediate potential risks.

Manages staff , including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.

Performs other duties as assigned.

Duties Continued

Education Required

Education Preferred

Experience

Required:
A minimum of 6-8 years’ experience in call center operations.

At least 4-5 years of supervisory/management experience.

Highly experienced with DHCS, DMHC, and Medicare regulations.

Facilitation of complex decision making among multiple stakeholders with competing priorities.

Experience working with regulatory agencies in meeting firm deadlines.

Experience in managing call center operations in a healthcare environment.

Skills

Required:
Knowledge of DHCS, DMHC, and Medicare regulations. Must have ACD/IVR system knowledge.

Excellent customer service, verbal, written, and interpersonal communication skills.

Strong interpersonal and leadership skills with ability to interact with cross functional project teams.

Demonstrated proficiency in budgeting, performance appraisal and coaching, time management, and training.

Ability to lead call center units in a fast-paced and changing environment.  Ability to lead multiple, large scale, diverse and complex initiatives simultaneously from beginning to end.

Ability to create departmental goals and objectives that align to organizational strategies.

Excellent time management and organizational skills; is dependable, enthusiastic, self-starting, and self-motivated. Reacts professionally under pressure.

Ability to trouble-shoot problem areas and implement effective process improvements.

Strong analytical and conflict resolution skills as well as persuasion skills. Ability to navigate and resolve employee escalations.

Proficient in MS Office applications, Word, Excel, PowerPoint and Access.

Ability to interpret and apply regulations.

Exercise good judgment and decision making.

Ability to troubleshoot and analyze root cause.

Strong relationship and rapport building.

Coaching, leadership and development of frontline leaders skills.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information

Senior Manager, CSC Call Center (1); Core Responsibilities: Medicare, L.A. Care Covered and Lead Generation Call Center Units

Senior Manager, CSC Call Center (2); Core Responsibilities: Direct Network, Medi-Cal and Provider Service Call Center Units