GENERAL SUMMARY:
To supervise, organize and coordinate the Provider Inquiry Call Center. To maximize service levels through scheduling, floor management, coaching and performance management. To maintain and report on all information related to the provider's inquiries received via the telephone/lobby and/or fax. Review, triage, and facilitate all information related to the Provider inquiries, complaints, or grievances received throughout the HAP systems.
PRIMARY DUTIES AND RESPONSIBILITIES:
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Supervise, develop, coordinate and control all workflow activities in the Provider Inquiry Department (which includes phone monitoring, scheduling staff & adjudicating the phone queue assignment schedule, based on trends to maximize the efficiency of the call center productivity). -
Determine training, policies, procedures and benefit needs related to customer servicing. -
Maintain quality control within Provider Inquiry based on Provide inquiry--- feedback via letters, phone, e-mail via HAP's website, provider survey cards, and quality audits performed by the department Quality Auditors. -
Evaluate employee performance, initiate appropriate coaching and developing and implement disciplinary action within area of responsibility. -
Develop the Call Center Statistical Analysis Reports on a daily/monthly/annual basis, including developing all associated written policies and procedures. -
Monitor the quality and quantity of the communication between the Client Service Specialists and customers received by telephone and/or in person. - Focus on continuous improvement on customer service and the development of staff in a customer oriented way.
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Interface with the Customer Services Correspondence and Grievance sections to be involved in the integral part of resolution for member complaints/grievances received by HAP. -
Develop processes/measures that will ensure staff receives continuing education on most current benefits, products, policies, procedures, systems tools, in cooperation with the departmental Training Coordinator. -
Assist and/or handle provider complaints received through the President's Office, Board of Directors, Media, Insurance Bureau, or the Department of Public Health ensuring a focus of customer satisfaction in complaint resolution. -
Coordinate with internal support departments, i.e., Marketing, Membership & Billing, Claims and Finance Divisions, in the resolutions of enrollment related problems. -
Perform other related duties as assigned.
EDUCATION/EXPERIENCE REQUIRED:
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Bachelor's degree in Health Care, Business or related field or a minimum of four (4) years recent and related work experience in customer service may be considered in lieu of the degree -
Minimum of three (3) years of experience in a health care or insurance environment -
Minimum of three (3) years of customer service experience in a call center environment and knowledge in claims processing and HMO, PPO and/or Medicare managed products -
Minimum of two (2) years of recent supervisory or team lead experience with evidence of driving customer service improvements. -
Demonstrate a clear understanding of health care delivery systems -
Demonstrate understanding of HMO/AHL health care concepts -
Demonstrate human relations management skills -
Demonstrate technical understanding of database-oriented computer systems, i.e. FACETS, PEGA -
Demonstrated proficient use of Microsoft Office software applications, i.e., Word, Excel, Power Point
Additional Information
- Organization: HAP (Health Alliance Plan)
- Department: CORRESPONDENCE
- Shift: Day Job
- Union Code: Not Applicable
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Henry Ford Health System
Jan 12, 2026