Company :Highmark Inc.Job Description : 

JOB SUMMARY

This job supervises and coordinates the day to day activities of the various call centers responding to inquiries received by members, providers, or account representatives across all markets.  Select, develop and continuously coach staff to the highest levels of performance.  Motivate and team build through the creation of a work environment and conditions that contribute to highest levels of performance.

ESSENTIAL RESPONSIBILITIES

Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.  Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.Monitor and manage daily inventories to ensure adequate staffing and resources are available to ensure performance guarantees and established goals are met and maintained.  Monitor calls for quality assurance. Oversee the performance of staff in the administration of service of these programs.   Select, train, motivate and develop the staff to enhance their performance and behaviors.   Create a work environment that recognizes rewards and motivates employees to continuously improve business processes to add greater value to the products and programs supplied to our members.  Manage alternative work schedules and actively guide and coach employees provide career development to maximize performance.Research quality issues and responds to error assessments.     Maintain department logs and documentation, analyze for trends in order to identify and initiate future pro-active measures.Ensure compliance with all regulatory entities (i.e., DOH, CMS, NCQA, etc.) Create, implement, monitor and report on the policies and procedures to ensure all required business/compliance standards are met. Represent the department compliance audits are it relates to the supervisor functions.Subject matter expert for benefit plan and claims processing.Other duties as assigned or requested.

EDUCATION

Required

High School/GED

Substitutions

None

Preferred

Bachelor’s Degree

EXPERIENCE

Required

2 years in customer service and/or claims environment3 years in leading or supervising employees in a highly regulated operations environment3 years with complex service computer systems (ex. OSCAR, INSING) and inquiry/benefits and handling of phone, written or web inquires

Preferred

3 years of working experience and knowledge of procedures and terminology for all lines of business (ex. medical terminology, interpretation of pharmacy policies, dental terminology and policy,  HARRIET, HCPCS codes, group benefits, complex pharmacy claim workflow (including claim adjudication of claim processing and/or rejections)

LICENSES or CERTIFICATIONS

Required

None

Preferred

None

SKILLS

Knowledge of multiple processing systems and workflows.Knowledge of various telephone or call center systems.Knowledge of all company products.Knowledge all applicable regulatory agencies and policies, (examples include: Pennsylvania Insurance Department regulations, HIPAA, TEFRA, SOX and Act 83 and Highmark Operational and Corporate Policies).Ability to communicate well in person, via phone and via e-mail (verbally and written).Ability to clearly articulate processes and procedures to all staff and management personnel.Ability to communicate, interact, and work effectively and cooperatively with all levels of staff and management teams.Ability to write basic internal business memos and desktop procedures, root cause/resolution analysis and flows

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Occasionally

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Never

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

EEO is The Law

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For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

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