Manager, Customer Service

About Us: Santa Clara Family Health Plan (SCFHP) is a local, community-based health plan dedicated to improving the health and well-being of the residents of Santa Clara County. Working in partnership with providers and community organizations, we serve our neighbors through our Medi-Cal and SCFHP DualConnect (HMO D-SNP) health care plans. About the role: The Manager of Customer Service provides day-to-day leadership and management to meet organizational goals and objectives. The incumbent has direct responsibility to develop, implement, and monitor all customer service activities in accordance with state and federal regulatory requirements, SCFHP policies and procedures and business requirements as set forth for each line of business. Day to Day: • Plan, supervise and manage the day-to-day department activities related to customer service call handling and transportation to ensure timely handling of member and provider calls to meet customer service performance objectives. • Manage the process of non-telephone tasks and activities, including, but not limited to resolution of exempt grievances, outbound call projects, member billing issues and communications sent through email or the SCFHP member and provider portals. • Oversee performance of customer service representatives; collaborate with the Manager, Customer Service Quality and Training to ensure that staff are properly trained and receive ongoing training and support to maximize competency and performance. • Collaborate with internal stakeholders to develop, maintain and improve training materials and department resources. • Measure, monitor, analyze, and report trend of performance service metrics at a department and individual to measure effectiveness and service levels. • Work cross-functionally with other business units to identify trends driving call volumes and support initiatives to identify and implement interventions to reduce avoidable calls and improve customer service quality. • Implement solid operational processes to support timely and accurate customer service to members and providers in compliance with regulatory requirements and company objectives; identify operational issues and formulate appropriate solutions. • Understand and manage reporting requirements for assigned lines of business in accordance with state and federal regulatory requirements and timelines. Conduct quality reviews of reports; track and trend, share information with other departments as needed and develop recommendations to improve operational procedures and staff performance. • Implement processes to support new and existing programs, membership, benefits. • Develop, implement, monitor, and maintain customer service policies and procedures in accordance with state and federal regulations. • Lead and facilitate regular Customer Service team meetings and in-service sessions, coordinate staff participation in member/provider education with all operational departments. • Providing effective leadership to attract and retain top talent to drive business results, including recruiting, interviewing, and hiring. • Developing a high performing department culture and staff. This includes setting the standard for staff/peers and motivating employees to maximize organizational goals and objectives. • Effectively assimilating, training and mentoring supervisors and staff and (when appropriate), cross training existing staff and initiating retraining. This includes coaching to help increase skills, knowledge and (if applicable) improve performance. • Setting goals, key performance initiatives, and planning, assigning, and directing work consistent with said goals. This includes responding to employees’ needs, and ensuring they have the necessary resources to do their work. • Appraising performance, rewarding and disciplining employees, addressing complaints and resolving issues. This includes providing regular and effective feedback to employees and completing timely and objective performance reviews About You: • Bachelor’s Degree in Business, Healthcare Administration or a related field or equivalent experience, training or coursework. • Minimum of three years of health plan experience in a lead or supervisory capacity. • Strong knowledge of Medi-Cal and/or Medicare managed health care. • Strong knowledge of customer service principles and best practices. • Sound understanding of health plan operations and the ability to monitor and understand trends in the industry and regulatory environment. • Ability to establish and maintain effective internal and external working relationships. • Ability to understand and apply practical implications of applicable rules, laws, regulations, program requirements, and industry guidance, and adjust direction as necessary to comply with regulatory requirements. • Excellent communication skills including the ability to express oneself clearly and concisely across all levels of the organization, with external constituents and with regulators, over the telephone, in person, in presentations or in writing. • Working knowledge and the ability to efficiently operate all applicable computer software including a working knowledge of and proficiency in, MS Office Suite applications including Outlook, Word, Excel, PowerPoint and Visio. Please review the full job description on our Career’s page: https://phf.tbe.taleo.net/phf04/ats/careers/v2/viewRequisition?org=SANTCLAR2&cws=38&rid=3101 Job Type: Full-time Pay: $111,168.00 - $172,310.00 per year Benefits: • 401(k) matching • Dental insurance • Employee assistance program • Flexible spending account • Health insurance • Life insurance • Paid time off • Retirement plan • Tuition reimbursement • Vision insurance Work Location: In person