Supervisor, Customer Solution Center Member Relations Navigator

Job Summary

The Supervisor, Customer Solution Center Member Relations Navigator is responsible for the development of a successful and cohesive Member Relations Navigator unit, with a high level of productivity to achieve the department's overall performance goals, and to meet and/or exceed member satisfaction.

The Supervisor is responsible for the supervision of Member Relations Navigators by closely monitoring performance, which includes but not limited to: coaching, mentoring, motivating, counseling to ensure they are providing optimal customer services and meeting and/or exceeding department goals. It is responsible for the overall delivery of benefits and services by providing support and guidance to customers to ensure continued membership. This position oversees first-level response and resolution of escalated issues with external and internal customers. Ensures all exempt grievances are handled with the required deadline and/or submitted within the guidelines of Appeals and Grievances. The Supervisor is involved in all Lines of Business. This includes, but it is not limited to, Medi-Cal, Cal-Medi-Connect (CMC), Personal Assistance Services Council (PASC), Healthy Kids, and L.A. Care Covered (LACC). Effectively manages and ensures the quality of the daily and monthly processes and operations to meet the unit's goals. This position troubleshoots and resolves issues with high quality customer service performance and sensitive to the population L.A. Care serves. This ensures compliance with Medicare and CMC.  Ensures processes and functions are compliant with relevant regulatory, contractual and organizational guidelines. Oversees the development and/or update of related departmental policies, procedures, process flows. The Supervisor is also responsible for effectively representing the department and the organization in various cross functional meetings, and committees. The Supervisor is also responsible for all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports that promotes continuous quality customer service improvement as previously described.

Duties

Supervise the day to day activities of Member Navigators, including but not limited to: providing direction, monitoring of staff performance, monitor to ensure all deadline for cases are met within the timeframe given, handling all questions/issues raised by staff, developing tools and procedures on training for staff including desk top procedures and organizational procedures for the all line of business (LOB) to meet all regulatory requirements, recommending process improvement processes, preparing and analyzing case reports, monitoring and ensuring all deadlines are met. Track and trend quality and recommend enhancement to improve quality. Prepare and review daily case load. Submit recommendations for staff's performance improvements. Ensure department's compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations relating to Protected Health Information (PHI).

Plans, organizes and supervises the activities for all staff. Serves as a leader and role model as well as a technical and informational resource for staff and peers; and, fosters a culture that encourages employee contributions.

Participates and leads special projects as assigned by the Manager and Director. Assists the Member Relations Manager with regulatory audits and requirements.

Develops and maintains a positive working relationships with all business partners to ensure optimum member care and satisfaction which includes interaction with all other departments for resolution of all cases.

Keep up-to-date with all changes related to LOB.

Perform other duties as assigned.

Duties Continued

Education Required

Education Preferred

Experience

Required:
At least 3-5 years customer service experience.

At least 1 year of leading a process, program or staff or supervisory/management experience in a health plan/health insurance customer service environment.

Minimum of 2 years of experience with Medicare.

Equivalency:  Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.

Skills

Required:
Must know medical terminology.

Must have excellent communication skills.

 
Strong analytical, time management, and training, coaching/mentoring skills, team building.

Ability to work effectively with diverse team members.

Must have the ability to troubleshoot problem areas and recommend effective alternative solutions to handle irate callers, and provide optimal customer service for internal and external customers.

Must be able to multitask and to streamline day to day operations, policies and procedures.
 
Must have advance PC skills including Excel and Access.

Preferred:
Bilingual in one of L.A. Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information