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    Supervisor, Customer Solution Center Member Relations Navigator - Los Angeles, United States - L.A. Care Health Plan

    L.A. Care Health Plan
    L.A. Care Health Plan Los Angeles, United States

    2 weeks ago

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    Description
    Salary Range: $77, Min.) - $100, Mid.) - $123, Max.)

    Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.

    Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

    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

    Bachelor's Degree
    In lieu of degree, equivalent education and/or experience may be considered.

    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

    Light

    Additional Information

    Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

    L.A. Care offers a wide range of benefits including
    • Paid Time Off (PTO)
    • Tuition Reimbursement
    • Retirement Plans
    • Medical, Dental and Vision
    • Wellness Program
    • Volunteer Time Off (VTO)
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