Claims Customer Service Supervisor

Key Responsibilities

• Team Management:
  • Supervise and lead the CSR team, providing guidance, support and mentorship, fostering a culture of respect, inclusivity and accountability.
  • Manage escalated customer service issues with empathy and professionalism, ensuring timely and effective resolutions.
  • Track and analyze team performance metrics, ensuring high quality assurance scores and continuous improvement.
  • Implement training programs and development initiatives to enhance team skills and knowledge.
  • Establish clear performance goals and expectations for the team, aligning with company objectives.
  • Provide regular feedback and coaching to CSRs to improve performance and address areas of growth.
  • Organize team building activities and initiatives to strengthen collaboration and morale.
• Customer Service Operations:
  • Supervise daily customer service operations, ensuring timely and accurate response to Medicare Supplement and Ancillary claim inquiries ensuring efficient workflow and timely responses.
  • Handle complex issues, claim escalations and complaints, providing effective solutions while maintaining customer satisfaction.
  • Maintain high standards of service quality, ensuring accuracy and professionalism in all interactions.
  • Identify and implement strategies for operational improvements and increased efficiency within the customer service department.
  • Ensure adherence to company policies, regulatory guidelines, and industry best practices in all customer service activities.
• Customer-Centric Focus:
  • Ensure all customer interactions are handled with accuracy, empathy and professionalism, providing timely and effective solutions that enhance customer satisfaction.
  • Foster a culture of customer-centricity within the team, encouraging CSRs to prioritize the needs and concerns of policyholders, providers and other stakeholders.
  • Equip CSRs with detailed and accurate information about Medicare Supplement benefits, insurance claims, and policy provisions, enhancing the overall customer experience.
  • Aid CSRs in achieving one-call resolution, ensuring that customer inquiries are addressed promptly and effectively, thereby improving customer satisfactions and operational efficiency.
  • Continuously seek ways to improve customer experience, implementing best practice innovative solutions to meet and exceed customer expectations.
  • Guide the team in gathering and analyzing customer feedback and QA scores to continuously improve service quality and customer satisfaction.
• Quality Assurance and Performance Metrics:
  • Achieve and maintain high customer satisfaction scores of 95% and above, ensuring exceptional service delivery.
  • Monitor and manage call abandonment rates, implement strategies for reduction and ensure customer calls are answered promptly.
  • Ensure high standards of service quality are maintained by regularly monitoring and evaluating CSR performance.
  • Analyze performance metrics to identify trends, areas for improvement, and opportunities for enhancing service delivery.
  • Implement feedback from quality assurance evaluations to drive continuous improvement in customer service practices.
  • Develop and conduct training sessions focused on quality assurance and performance enhancement.
• Continuous Improvement:
  • Regularly evaluate existing processes to identify inefficiencies and areas for improvement.
  • Implement innovative strategies and solutions to enhance operational efficiency and service quality.
  • Integrate feedback from customers and team members into continuous improvement initiatives, improve workflows, systems and procedures.
  • Use performance metrics to track progress and measure the impact of improvement efforts.
  • Stay informed about industry trends, best practices, and regulatory changes to ensure the customer service team remains current, effective and compliant.
  • Develop and conduct training programs focused on continuous improvement and skill enhancement.
• Stakeholder Collaboration:
  • Maintain clear and proactive communication with internal and external stakeholders, including policyholders, providers, beneficiaries, and agents to ensure effective issue resolution.
  • Collect and analyze information from stakeholders to address concerns and improve service delivery.
  • Collaborate with other departments to ensure seamless service delivery and address customer needs efficiently.
  • Foster strong relationships with stakeholders to build trust and ensure ongoing collaboration.

Qualifications

• Experience:
  • 3+ years of experience in a healthcare customer service role, with at least 1 year in a supervisor position.
  • Proven experience in a supervisory or leadership role within a customer service environment, preferably in the healthcare industry.
  • Demonstrated ability to monitor, evaluate and improve team performance through quality assurance and performance metrics.
  • Strong skills in managing escalated customer issues and resolving conflicts with empathy and professionalism.
  • Experience in identifying and implementing process improvements to enhance operational efficiency and service quality.
• Skills:
  • Strong verbal and written communication skills to clearly convey information and instructions.
  • Proficiency in identifying issues, developing solutions, and resolving conflicts in a professional manner.
  • Ability to manage multiple tasks efficiently and prioritize workload in a fast-paced environment.
  • Advanced skills in using customer service software, databases, and related tools.
  • Experience in conducting training sessions and developing training programs to enhance team skills and knowledge.
  • Strong ability to analyze performance metrics, prepare reports and provide actionable insights.
  • Capability to adapt to changing circumstances and work effectively, in a dynamic environment.
  • Deep understanding of customer service principles with a commitment to providing exceptional service.
  • Keen eye for detail to ensure accuracy in claims adjudication and policyholder/provider interactions.
• Education:
  • High school diploma or equivalent; associate or bachelor’s degree preferred.