Customer Service Manager

This position will provide leadership and drive results for all aspects of member service in compliance with regulations and guidelines.
This position is also responsible for leveraging technology to enhance the overall member experience and build on department efficiencies.
This position will be responsible for strategic and operational planning for areas of responsibility, which includes business processes, key performance metrics, collaboration, project management and operational excellence by performing the following duties.
* Provides operational leadership for member services strategy and initiatives, such as member experience, outreach, touchpoint efficiencies, resolutions, and engagement.
* Provides oversight of member communications for both inbound and outbound communications and campaigns, and tracks and monitors progress and performance.
* Develops and maintains policies, procedures, workflows, and forms for Member Services including the Grievance and Appeals System.
* Serves as the lead for overall member services success and develops and implements the Member Services strategic plan, dashboards, reporting, and Key Performance Indicators (KPI).
* Facilitates a high-quality implementation of member onboarding and the necessary touchpoints for retention success.
* Leads efforts of research, development, and implementation of technology tools to enhance the member experience and strives toward one-call resolution standards.
* Trains organization on Member Experience and the Grievance and Appeals System and processes.
* Conducts thorough investigations of member and provider correspondence by analyzing all the issues involved and obtaining responses and information from internal and external entities.
* Maintains detailed interactions with members which includes contacting the member and/or provider to collect information, resolve conflict, communicate final disposition of the case, and is lead for Grievance and Appeals systems escalations.
* Directs and validates appropriate productivity, engagement and performance metrics are established and met, and ensures department goals and KPIs are routinely communicated to key partners and throughout the organization.
* Ensures effective use of operational analytics to proactively monitor, forecast and identify trends in member services and engagement.
* Oversees member communication campaigns and collateral to ensure outreach is effective and positively impacts the target audiences.
* Tracks and monitors call volume and quality to improve performance and build department efficiencies.
* Ensures policies and procedures are established and maintained to ensure efficient operations and compliance with federal and state regulatory and contractual requirements.
* Maintains annual calendar of state deliverables for member communications, grievances, appeals, hearings, and NOABDs.
* Ensures the member perspective is appropriately represented and integrated into member services operations and shared across the various cross-functional departments.
* Collaborates with internal departments and external parties to continually enhance the member experience and engagement model.
* Implements and optimizes workforce management tools for resource planning and balancing.
* Instills work culture of continuous process improvement, engagement, innovation, and quality to realize operational and member experience excellence.
* Leads the development of vision, strategy, and goals for member service for the organization and monitors progress towards achieving those goals.
* Develops and maintains department strategic plan and participates in the strategic planning process for the organization.
* Participates in internal and state and community/county committees as applicable.
* Maintains confidentiality and complies with HIPAA rules and regulations.
* Maintains punctual, regular, and predictable attendance.
* Works collaboratively in a team environment with a spirit of cooperation.
* Identifies and engages with clinical resources, as deemed necessary, using sound, fact- based decision-making skills to render a decision for non-clinical complaints.
* Displays excellent communication skills including presentation, persuasion, and negotiation skills required in working with members and coworkers, including the ability to communicate effectively and remain calm and courteous under pressure.
* Respectfully takes direction from manager.
EDUCATION and/or EXPERIENCE Bachelor's degree from four-year college or university; and four to six years related experience and/or training; or equivalent combination of education and experience.
COMPUTER SKILLS Job requires specialized computer skills.
Must be adept at using various applications including database, spreadsheet, report writing, project management, graphics, word processing, presentation creation/editing, communicate by e-mail and use scheduling software.
This position will be full time in the office in Klamath Falls with the potential for remote work from time to time.
We provide a competitive salary and excellent benefits, including vacation, medical, dental and vision insurance, and 401(k) pension plan.
To apply for this position, please submit a cover letter and resume.
We are an Equal Opportunity Employer.
Job Type: Full-time Pay: $1.
00 per hour Benefits: * 401(k) * 401(k) matching * Dental insurance * Flexible schedule * Flexible spending account * Health insurance * Paid time off * Tuition reimbursement * Vision insurance Shift: * 8 hour shift Weekly day range: * Monday to Friday Work Location: In person