Lead UM Services Rep - 00001

Summary:

This position supports operational strategies and daily operations of the Utilization Management (UM) Services team. As a subject matter expert this position supports the team with regard to efficiency, and quality.

Essential Responsibilities/Accountabilities:

• Provide support, coaching, and training to UM Services Specialists.
• Conduct department quality audits for calls and built authorizations.
• Assist with calls and offline work when needed to remain within Utilization Management timeframes.
• Responds to customers in a professional, efficient manner to encourage public acceptance of products, services, and policies.
• Perform triage for Utilization Management.
• Assists and performs tasks associated with project and departmental management.
• Continuously works to identify and remove barriers to increased productivity, quality, cost effectiveness, and timeliness.
• Collaborates with internal and external customers to analyze and respond to complaints and satisfaction concerns. This will include root cause analysis, process improvement and inquiry resolution.
• Resolves escalated customer questions and complex concerns.
• Provides oversight of all UM Services related work including telephonic, web & fax requests, ensuring all are managed within required compliance thresholds.
• Assists supervisor with assigned tasks when necessary.
• Reports findings to management based on quality audit performance and observed experiences.
• Assists in updating departmental policies, procedures, and desktop manuals relative to the department functions. Identifies and develops administrative processes and guidelines for performance improvement.
• Participates in system testing and provides input on program development and implementation strategy, from a user perspective, on an ongoing basis.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Minimum Qualifications:

• High School Diploma or GED with a minimum of five years' relevant customer service experience.
• Experience with using a desktop computer in a professional environment, preferably with Microsoft Office products.
• Call Center experience required.
• Strong analytical and problem-solving skills.
• Strong written and verbal communication skills and ability to work well with professional contacts throughout the Health Plan.
• Demonstrated ability to prioritize competing demands.
• Self-motivated and able to work independently, as well as on intra- and inter-departmental teams where needed.
• Working knowledge of healthcare related call center systems and claims workflow preferred
• Extensive knowledge of insurance contracts, medical, hospital and dental procedures preferred.
• Proven leadership ability, including motivating and coaching workforce, communication, human relations and negotiation skills
• Knowledge or demonstrated skills in workflow management and improvement implementation
• High degree of discretion in dealing with confidential information

Physical Requirements:

Environment/workstation

• Ability to work prolonged periodssitting at aworkstationand working on a computer.
• Abilitytoworkwhile sittingand/or standing whileat aworkstationviewing a computer and using a keyboard,mouseand/or phoneforthree (3)or more hours at a time.
• Ability to work in a home office for continuous periods of time for business continuity.

Travel

• Ability totravelacross theHealth Plan serviceregionfor meetings and/or trainings as needed.

Other Motions

• Manual dexterity including fine finger motion required.
• Repetitive motion required.

Additional Requirements on current JDs

• The ability to hear, understand and speak clearly while using a phone, with or without a headset.

The Lifetime Healthcare Companies aims to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.

Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.

OUR COMPANY CULTURE:

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)