Customer Service Manager

Work from Home – Remote

@Orchard LLC is supporting a not-for-profit corporation that partners with public and private sectors to create high-quality, safe, and efficient delivery of health care and human services programs. Our client has multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Our client is also a national leader in fighting fraud, waste, and abuse for large organizations across the country.  In addition, our client operates a foundation providing grant opportunities to those with programs for under-served communities.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Leads complaint specialist team who determines the disposition of potential fraud cases and educates beneficiaries and providers on eligibility, premiums, out-of-pocket costs, and the rationale and scope of benefits.
• Makes appropriate referrals to the Program Integrity Intake team for potential fraud related complaints.
• Assists Call Center Project Manager in development of complaint and customer service processes including call scripts, educational materials, tracking systems, and reporting.
• Assures timely screening and referral of complaints to appropriate benefit integrity, Medicare Part D authorities, and prescription drug plans, and CMS.
• Provide presentations to client and team on trend issues as needed.
• Maintains working knowledge of customer needs and contract requirements, deliverables, resource requirements, and operations efficiencies.
• Responds to client needs for information and clarification via the telephone and in writing.
• Responds to client requests for reviews by initiating appropriate forms or giving directions.
• Assist in preparing monthly reports of complaint specialists activities.
• Remains current on changes in QA processes and regulatory issues.
• Protects and maintains the privacy of associate personnel records, including compensation information.

Supervisory Responsibilities                                                   

·         Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, training, and developing employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

Required Skills:

To perform the job successfully, an individual should demonstrate the following competencies:

• Analytical - Collects and researches data; Uses experience to complement data.
• Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations.
• Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
• Delegation - Gives authority to work independently; Sets expectations and monitors delegated activities.
• Quality Management - Looks for ways to improve and promote quality.
• Judgment - Exhibits sound and accurate judgment; Supports and explains reasoning for decisions.
• Planning/Organizing - Prioritizes and plans work activities; Sets goals and objectives.

Required Background:

• High school required with a minimum of three years of prior experience coaching staff and leading a customer service team; AA or Bachelor's degree preferred.
• May consider an equivalent combination of education and experience;  

• Familiarity with prescription drug benefits and Medicare and/or experience in providing services and supports of beneficiaries, customer relations, call centers, and healthcare is preferred.
• Multi-lingual capabilities preferred

If you match the requirements for this opportunity and believe you have the experience and talent to succeed in the role, we need to hear from you!

Established in 2010, @Orchard LLC, also known as, Talent Orchard has an exceptional reputation, providing staffing solutions to time-sensitive, talent scarcity issues to deliver better talent management ROI.  Our specialty lies in the critical area of program talent acquisition and resource management, not in one narrow skillset, but across many areas of technical and functional delivery. To learn more about our other exciting opportunities, visit our Jobs Page at www.atOrchard.com.