Manager Medical Customer Service

Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare by offering outstanding coverage to our members, compassionate support to our community, and comprehensive benefits to our employees. We connect with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace; our diverse experiences and perspectives help us become a stronger organization.

About the role

This is a full-time hybrid position based in Milwaukie, Oregon. The role develops and maintains customer service policies, procedures, and guidelines for multiple lines of business in Oregon, Alaska, Idaho, and Texas: Commercial medical groups (including ASO and fully insured groups) and Individual medical groups. The position ensures prompt, efficient, and accurate information is provided to staff, members, providers, and group administrators. You will work closely with supervisors and senior leadership to develop, implement, and ensure consistency of processes and procedures across each line of business. Responsibilities include staff organization, service-level performance, goal setting, coaching, motivation, and staff development.

Responsibilities

• Manages and oversees all functions within the Medical Customer Service team.
• Ensures all Moda performance guarantees, NCQA requirements, call goals, voicemail callbacks, and email statistical goals are met.
• Provides mentoring and development for supervisors to ensure performance standards are met.
• Participates in workgroups to offer solutions and suggestions that support department goals.
• Manages current processes and develops innovative solutions to meet and exceed department measures and metrics.
• Plans, organizes, and directs department workflow to ensure staff performance expectations, including quality and quantity goals, are reasonable and met.
• Reviews performance issues with supervisors and takes disciplinary action when appropriate.
• Drafts, implements, approves, and executes policies and procedures that support a quality customer service experience.
• Assesses and oversees process improvement implementation plans to ensure departmental processes are efficient; evaluates and modifies them as appropriate.
• Ensures prompt, efficient, and accurate customer service administration by developing and implementing appropriate goals with the Director.
• Reviews monthly, quarterly, and annual statistical reports.
• Ensures language access contracts for member and provider vendors are in place and functioning as intended.
• Provides written narratives and reviews data for quarterly NCQA reports for Commercial Medical in all states.
• Provides direction to supervisors and keeps them informed of expectations and performance on a monthly basis; sets short-term and long-term objectives for supervisory staff and provides resources to ensure goals are met.
• Provides constructive and timely performance evaluations.
• Oversees hiring, training, orientation, performance appraisals, scheduling, and corrective action for staff.
• Recruits, interviews, hires, and trains departmental supervisory staff.
• Coordinates with the Training Manager, Operations teams, and supervisors to provide initial and ongoing staff training.
• Works with the Director to review and advocate for departmental staffing projections and budget needs; recommends appropriate staffing requirements based on projected new sales and business retention.
• Coordinates with Human Resources and supervisors to ensure departmental recruitment efforts remain on track.
• Works cooperatively companywide with Claims, Membership Accounting, Marketing, Operations, Healthcare Services, Compliance, and Sales and Service Management; serves on project teams and committees for all areas as appropriate.
• Provides annual review of plan documentation, websites, and benefit programs to ensure accurate annual updates for medical departments.
• Provides oversight and direction for departmental involvement in various annual user acceptance testing projects.
• Identifies areas for improvement within departments and across functions; leads improvement efforts where appropriate and evaluates and manages cross-training to maximize productivity.
• Ensures phone lines are directed correctly for weekend and holiday coverage and are adequately staffed for Texas lines of business.
• Performs other duties as assigned by leadership.

Requirements

• Bachelor’s degree or equivalent work experience specializing in business administration, customer service, and/or health insurance.
• Minimum of four years of supervisory experience in medical, dental, and/or pharmacy customer service.
• Demonstrated ability to effectively manage multiple lines of business concurrently.
• Knowledge and understanding of Medicaid, Medicare, pharmacy, medical, and dental programs.
• Ability to instruct, motivate, and direct individuals at various skill levels, both face-to-face and in a virtual environment.
• Demonstrated strong, effective, and diplomatic interpersonal skills with employees at all levels.
• Strong presentation skills.
• Excellent reading, oral, and written communication skills, with the ability to interact professionally, patiently, and courteously with internal and external customers.
• Strong problem-solving and decision-making skills.
• Ability to work well under pressure in a complex and rapidly changing environment.
• Ability to maintain confidentiality and project a professional business presence and appearance.
• Knowledge and understanding of contracts and administrative policies affecting claims.
• Demonstrated consistent ability to comply with company rules and policies.
• Maintains attendance above company standards.

Pay

$78,911.43 - $98,639.28 annually (depending on experience). Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.

Benefits

• Medical, Dental, Vision, Pharmacy, Life, & Disability coverage
• 401K with matching
• Flexible Spending Account (FSA)
• Employee Assistance Program
• Paid Time Off (PTO) and Company Paid Holidays

Working Conditions

Work is performed while seated or standing for prolonged periods. The position requires close work with a PC monitor and keyboard, along with constant interaction with others by phone, virtually, and in person. The role may require working more than 40 hours per week, including evenings and occasional weekends, to meet business needs. Interacts internally with staff and departments at all levels, and externally with members, providers, policyholders, group administrators, vendors, and other insurance carriers.