Member and Provider Service Supervisor

WellSense Health Plan; Boston (MA); Remote; USD 58,000 - 84,000; Full time

Benefits offered by this job

Full-time remote work

Competitive salaries

Excellent benefits

Job summary

WellSense Health Plan is seeking a Member and Provider Service Supervisor to lead a team delivering exceptional service to members and providers. The role focuses on policy development, process optimization, and ensuring adherence to state and corporate standards across multiple product lines.

The supervisor will guide staff, coordinate with partner departments, and drive continuous improvement while maintaining high service levels and timely issue resolution in a fast-paced environment.

Qualifications

• Bachelor's degree or equivalent combination of education, training and experience preferred.
• Three or more years of call center experience preferred.
• Three or more years of supervisory experience preferred.
• Three or more years of healthcare or managed care experience preferred.

Responsibilities

• Implements department policies, supervises telephonic and office operations to meet productivity targets and quality standards.
• Develops policies and procedures to ensure outstanding service delivery and satisfaction.
• Analyzes call volumes and optimizes staffing to meet inbound demands and performance goals.
• Ensures monthly compliance with corporate standards and state requirements.
• Maintains interdepartmental processes to support services across product lines.
• Monitors staff adherence to workflows and provides guidance as needed.
• Resolves policy questions and collaborates with partner supervisors to resolve.
• Ensures staff have tools and training for outstanding customer service.
• Collaborates with Trainer to identify training opportunities and deliver them effectively.
• Leads cross-functional projects and allocates resources appropriately.
• Represents department in cross-functional initiatives and performs other duties as needed.

Skills

Critical thinking

Analytical skills

Communication skills

Project management

MS Office

Education

Bachelor's degree or equivalent

Tools

FACETS

AVAYA

CCMS

Job description

Job Summary

The Member and Provider Service Supervisor is responsible for ensuring the delivery of outstanding customer service resolving issues and delivering accurate information to WellSense members and providers. The Member and Provider Service Supervisor is responsible for participating in the recommendation, development and implementation of short and long-term quality service strategies that improve member and provider satisfaction and Member and Provider Service operations. Additionally, the Member and Provider Service Supervisor will serve as needed as a subject matter expert and resource.

The Member and Provider Service Supervisor is responsible for ensuring the delivery of outstanding customer service resolving issues and delivering accurate information to WellSense members and providers. The Member and Provider Service Supervisor is responsible for participating in the recommendation, development and implementation of short and long-term quality service strategies that improve member and provider satisfaction and Member and Provider Service operations. This role is responsible for the direct supervision of Member and Provider Service Center staff and ensures that all necessary tools and resources are available to meet or exceed state contractual requirements and corporate standards servicing members and providers across product lines. The Supervisor is also responsible for proactively and methodically identifying and resolving service barriers (including but not limited to claims, eligibility, enrollment, prior authorization and benefits) working with partner departments as needed to do so. Will work in close collaboration with the Member and Provider Service management team to ensure that the Member/Provider Service provides members and providers with the highest levels of customer service, meets applicable requirements and standards and strives for continuous improvement.

Our Investment In You

• Full-time remote work
• Competitive salaries
• Excellent benefits

Key Functions/Responsibilities

• Implements Member and Provider Service department policies, procedures and standards, and supervises – Member and Provider Service telephonic and office operations to achieve productivity targets, quality standards and operational goals.
• Participates in the development of policies and procedures to ensure outstanding service delivery and member and provider satisfaction.
• Responsible for the daily analysis of call volumes, monitoring and adjusting staff resources (scheduling) to meet inbound demands (provider) and performance goals and maximize efficiency.
• Ensures monthly compliance with corporate standards.
• Establishes, maintains and refines intradepartmental and interdepartmental processes and procedures to support Member & Provider Services work processes across product lines.
• Monitors staff to ensure compliance with established workflows.
• Resolves first line policy questions referred by staff and works with partner supervisors and managers as needed to resolve.
• Ensures Member & Provider Services staff has the technology and training needed to provide outstanding customer service.
• Works in close collaboration with the Trainer to identify training opportunities (and optimum delivery method) to enhance customer service through the use of metrics and staff feedback. Trains or oversees training of staff.
• Works as a member of the Member & Provider Services management team to ensure appropriate work allocation and adherence to all state requirements by sharing resources when necessary.
• Conduct one-on-one quality feedback sessions with direct reports to coach and develop the team
• Take client/ customer calls and fill in for Assists as needed
• Must be motivated, adaptable, flexible, and able to produce quality results in an evolving, fast paced environment
• Detail oriented, excellent organizational skills and ability to multi-task
• Monitors call trends to proactively identify existing and potential member and provider service issues.
• Assists and participates as needed in budget planning.
• Contributes to development and maintenance of member and provider materials.
• Be flexible with shifts and hours as we are an 8a-8p 7 day operation at certain times of the year.
• Maintains current knowledge of WellSense and payment and reimbursement policies, member coverage and benefits, and claims adjudication rules.
• Maintains current knowledge of WellSense benefits, provider network development and contract issues, Massachusetts Medicaid regulations, state and WellSense payment and reimbursement policies and industry standards for claims processing issues.
• Maintains current knowledge of FACETS Customer Service Module, AVAYA, CCMS, and all systems used by Member & Provider Services staff and management.
• Leads project activities including assigning tasks, determining project schedule and resolving project issues.
• Represents department on cross-functional initiatives.
• Performs other tasks as needed as a member of the Member and Provider Service management team to meet the goals of Member & Provider Services and WellSense.

Supervision Exercised

• Supervise 5-15 staff.

Education

Qualifications :

• Bachelor's degree or an equivalent combination of education, training and experience is preferred.

Experience

• Three or more years call center experience preferred.
• Three or more years experience in healthcare or managed care is preferred.
• Three or more years supervisory experience preferred.

Competencies, Skills, And Attributes

• Demonstrates exceptional critical thinking and analytical skills.
• Understands cause and effect and possesses strong problem-solving skills.
• Strong oral and written communication skills and ability to interact within all levels of the organization.
• Effective collaborative and proven process improvement skills.
• A strong working knowledge of Microsoft Office products.
• Demonstrated ability to successfully plan, organize and manage projects.
• Detail oriented, excellent proof reading and editing skills.

Compensation Range

$57,500- $83,500

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.

Note: This range is based on Boston-area data, and is subject to modification based on geographic location.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees