Broker Services Specialist III

About the role

L.A. Care Health Plan, the nation's largest publicly operated health plan, is seeking a Broker Services Specialist III to serve as the Subject Matter Expert (SME) on day-to-day duties involving collaboration with external business units such as sales operations and compliance, Finance (MPSS), and I.T. This position builds and maintains positive and professional relationships with L.A. Care's contracted General Agencies (GA) and their contracted Agents, providing training and basic knowledge on L.A. Care and specified lines of business. The Broker Services Specialist III serves as the primary Point of Contact with our finance unit to ensure agent sales commissions are reconciled and paid within the pay period, and is responsible for supporting L.A. Care's Direct Agent Service Model (DASM).

Responsibilities

• Customer Relations (40%): Manages inside support requirements of multiple inquiries from the contracted broker community and manages the operations of L.A. Care's DASM. Maintains relationships by answering inquiries from brokers via Sales Force, telephonic, or any alternate communication. Follows through with timely responses, including research and resolution, as established by department KPIs and maintains follow-up with key GA partners who are part of the DASM to ensure all submitted change requests are completed by the Broker Support team in a timely manner. Manages broker profiles in Salesforces to ensure data accuracy. Acts as point of contact for stakeholders and provides updates accordingly to daily/weekly/monthly meetings with leadership.
• Sales Operations/Compliance and Regulatory Requirements (10%): Serves as a liaison to Sales Operations and assists with general agency contracting and agent onboarding, offboarding, transfer request processing for L.A. Care Medicare Plus (DSNP), L.A. Care Covered (LACC), and other product lines added. Serves as liaison to Finance (MPSS) for commission reconciliation and payments. Assists with processing of new agent requests, agent inquiries inbox, management of license expirations, generation of appointment agent report for Finance, generation/validation of compliance reports for Brokers, Office of Inspector General (OIG) report, agent termination report (LACC), America's Health Insurance Plans (AHIP) tracking and update. Works with internal Sales compliance staff to monitor sales regulations and adherence to State and Federal Marketing guidelines. Works with systems to ensure appropriate data is collected for auditing purposes. Works with IT for testing and implementation of system updates or upgrades.
• Information Technology (10%): Assists in the development of broker portal enhancements from an Agent perspective internal/external. Researches best practices and supports developing the solutions and recommendations for the current business operations.
• Communications (10%): Assists in developing advisories in collaboration with the Business Development Program Manager II in order to provide communications related to Open Enrollment, Annual Enrollment Period, product line updates and notices to the General Agencies. Represents L.A. Care with Broker and Strategic Partners by participating in any L.A. Care related functions in support of growth for broker and partners. Represents L.A. Care's DASM by serving as the liaison with GA partners to ensure all submitted requests are processed on time in order to retain broker partner satisfaction. Manages external communication inquiries from L.A. Care's contracted General Agencies via Agent Support inbox, Agent Support call queue and work phone line.
• Monitor and Track Caseload (10%): Monitors and tracks the progress and outcomes of partnerships through documentation and communication to management. Reviews frequent reports to ensure inquiries are closed out according to KPIs. Maintains CRM tracking of general agency and agent profiles and other key information. Ensures documentation meets standards through regular audits. Maintains communication with management regarding trends of inquiries through daily tracking. Reviews all submitted problem and improvement reports; identifies priority issues; evaluates opportunities for improvement, presents findings to supervisors for evaluation and prepares resolution work plan as directed. Develops and executes test plans. Monitors all solutions through to resolution. Maintains key log of all agents participating in Direct Agent Service Model and ensures all compliance requirements are received and stored. Updates regular reporting on agent inquiries and ensures timely case resolution.
• Training and Mentorship (10%): Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that facts and details are correct so that deliverables meet the needs of the department, organization, and legislation's policies, standards, and best practices. Recommends process improvements, and mentors junior level staff, department interns, etc. as needed. Provides training and onboarding of new hires, ensuring successful access to all systems needed for the Broker Support Role. Provides mentorship to Broker Support team by providing daily trainings, assistance, and constant communication via emails, meetings (huddles), and WebEx messenger. Creates workload inquiries and delegates to staff. Creates Staff schedules during Open Enrollment/Annual Enrollment Period in order to meet business requirements. Develops desktop level procedures as an SME in order to maintain compliance measures, in addition to providing staff with a frame of reference for job duties.
• Perform other duties as assigned (10%).

Requirements

• Associate's Degree in Healthcare Administration or Related Field (in lieu of degree, equivalent education and/or experience may be considered)
• At least 2 years of experience in a health plan or broker related environment, including interface of the following functions: Broker Support role, sales outreach and enrollment, customer service, project coordination; working knowledge and understanding of production regulations, including Medicare, Medi-Cal and Covered California
• Medi-Cal and Medicare Training Certification (or must be obtained within 90 days from date of hire)
• Product trainings - MediCal, L.A. Care Covered, Medicare

Skills

• Proven ability to significantly impact process improvement and process management
• Ability to document scope and project tasks in a clear and concise manner
• Thorough understanding of relevant industry practices, techniques and standards
• Comprehensive understanding of business process/life cycle management principles, theories and concepts
• Excellent problem-solving/analysis/computational skills
• Proficiency in Microsoft Office applications and database management
• Ability to articulate relevant information and directions in an organized and concise manner
• Excellent interpersonal, verbal, and written communication skills
• Understanding of effective communication concepts, tools and techniques
• Excellent collaboration skills
• Ability to interact successfully with both internal and external customers at all levels
• Ability to conform to shifting priorities, demands, and timelines through analytical and problem-solving capabilities
• Ability to effectively train onboarding staff through virtual or hands-on approach
• Persuasion skills: Represent Manager in meetings; demonstrate leadership and interpersonal communication skills by working collaboratively and effectively with peers, superiors and subordinates to accomplish objectives; able to concisely, clearly and formally communicate complex concepts and formulate process solutions

Preferred Qualifications

• Experience with assisting beneficiaries in Covered California and Medicare
• Experience in project management
• Knowledge of CRM systems and navigation for contact resolution
• Life & Health License - Active, current and unrestricted California License (within 90 days of hire)
• America's Health Insurance Plan (AHIP) Medicare Designation and Covered CA Certification (or must be obtained within 90 days from date of hire)

Pay

Salary Range: $60,778.00 (Min.) - $75,950.00 (Mid.) - $91,166.00 (Max.)

Benefits

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental and Vision
• Wellness Program
• Volunteer Time Off (VTO)