Manager Customer Service - St. Luke's Health Plan

Overview:

The Customer Service Manager for the St. Luke's Health Plan is responsible for ensuring exceptional member experiences while overseeing the customer service operations and managing appeals and grievances. The role requires extensive knowledge of benefits across various lines of business, including individual on and off exchange, small group, large group, self-funded, and Medicare Advantage plans. The Customer Service Manager will develop and lead a team dedicated to providing top-tier service to St. Luke's Health Plan members, handling inquiries through multiple channels with efficiency and empathy.

Responsibilities:

Lead and motivate a team of customer service representatives and appeals/grievance specialists.

Set clear objectives and performance expectations. Provide ongoing feedback to team members to drive excellence in service delivery. Foster a positive and collaborative team environment that encourages continuous learning and development.

Ensure all interactions with members are handled professionally, promptly, and with empathy. Implement strategies to enhance the overall member experience and satisfaction, including process improvements and service enhancements. Monitor service quality metrics and survey feedback. Implement corrective actions as needed to address gaps and drive improvement.

Maintain detailed knowledge of benefits for multiple lines of business. Stay updated on changes to benefits, plan offerings, and regulatory requirements to provide accurate and up-to-date information to members.

Emphasize the importance of promptly following up on inquiries. Implement procedures to track outstanding issues and monitor progress toward resolution. Work closely with other departments to address and escalate unresolved issues. Conduct regular reviews of open issues and take proactive measures to expedite resolution, demonstrating a commitment to delivering exceptional service and responsiveness to member needs.

Manage inquiries and escalations received through various communication channels, including phone calls, emails, chat, and other channels as appropriate. Ensure consistent, high-quality responses across all channels ensuring a unified brand voice and messaging.

Monitor call center performance metrics, such as average handle time, first call resolution, and customer satisfaction scores. Generate reports and analyze data to identify trends, areas for improvement, and opportunities to optimize operational efficiency.

Oversee the handling of appeals and grievances, ensuring timely and compliant resolution. Work closely with internal departments, including utilization management, claims, and compliance to address appeals and grievances and resolve issues effectively. Develop and implement processes to track and analyze appeals for trends and insights to inform process improvements.

Adhere to all applicable laws, regulations, and industry standards including HIPAA guidelines.

Participate in quality assurance initiatives to ensure accuracy and consistency in customer service and appeals and grievance handling, including HIPAA guidelines.

Stay informed about changes in healthcare regulations, insurance policies, and industry trends through ongoing training and professional development opportunities.

Responsible for full employment life cycle for staff to include hiring, termination, performance management, coaching, training, and mentoring.

Minimum Qualifications:

Education: Bachelor's Degree or experience in lieu of degree

Experience: 5 years relevant experience

Licenses/Certifications: None

Why St. Luke's:

At St. Luke’s, caring for people in the communities we serve is our mission – and this includes our own SLHS team. We offer a robust benefits package to support our teams both professionally and personally. In addition to a competitive salary and retirement plans, we ensure our team feels supported in their benefits beyond the typical medical, dental, and vision offerings. We care about you and have fantastic financial and physical wellness options, such as: on-site massages, on-site counseling via our Employee Assistance Program, access to the Virgin Pulse Wellness tool, as well as other formal training and career development offerings to ensure you are meeting your career goals.

St. Luke’s is an equal opportunity employer and does not discriminate against any person on the basis of race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.

*Please note: this posting is not reflective of all job duties and responsibilities and is intended to provide an overview to job seekers.

Permanent