It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

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.

Our Investment in You:

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

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 worksin close collaboration with the Member and Provider Service management team to ensure that the Member/Provider Services provides members and providers with the highest levels of customer service, meets applicable requirements and standards and strives for continuous improvement. 

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:

• Supervises 5-15 staff

QUALIFICATIONS:

EDUCATION:

• Bachelor’s degree or an equivalent combination of education, training and experience is required

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, preferably in claims operations or claims data setting

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

ABOUT WELLSENSE

WellSense Health Plan is a nonprofit health insurance company serving more than 440,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded 25 years ago, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.

*WellSense will require proof of COVID-19 vaccination(s) as a term of employment for all employees. The company may make exceptions to this requirement in certain limited circumstances for religious or medical purposes.

Required Skills Required Experience