Director Customer Service - Medical

Job Description

Position Responsibilities:

• Administer and coordinate all enrollment activities, health plan assignments, and member educational programs and data collection for Medi-Cal and as appropriate Healthy Families, and Medi-Cal/Medicare members.

• Oversee assessment activities and analysis to identify member needs.

• Assure timely placement of members with a health plan and a primary care physician.

• Act as a liaison between the company and external agencies regarding member issues.

• Oversee member outreach and education activities.

• Provide oversight in the resolution of member problems and concerns.

• Ensure compliance with all relevant state requirements regarding Customer Service.

• Manage employees directly and through subordinate managers including selection, training, performance appraisal, performance goal setting, and resource allocation.

• Develop policies, procedures and standards for all department activities and member processes.

• Develop and monitor departmental budget.

• Other projects and duties as assigned.

Required Skills:

• Plan, organize, and direct beneficiary enrollment and member services.

• Ensure timely resolution of member related problems.

• Oversee the maintenance of records and reports.

• Communicate in a clear and concise manner with personnel at all organizational levels both internally and externally and with diverse social, cultural and ethnic populations.

• Develop and maintain effective collaborative relationships with other departments, programs, agencies and the general public.

• Effective listening and communicating skills for telephone and face-to-face interactions.

• Effectively utilize computer and appropriate software and interact as needed with Information Systems.

Qualifications

Experience & Education:

• 5-7 years experience that would provide the knowledge and abilities listed, including 3 years supervisory experience.

• HMO, Medi-Cal/Medicaid, Medicare and insurance experience or relevant government client or public service experience preferred.

• High school diploma or equivalent required. Relevant Bachelor’s degree or related health care experience; Master’s degree desirable.

• Minimum 5 years of health care management experience, preferably in managed care environment in related area of responsibility, i.e. utilization management, quality management, grievances and appeals.

• Strong interpersonal skills including coaching staff, and handling conflict resolution.

Knowledge of:

• Principles and methods of planning, directing and maintaining compliance with eligibility determination and service standards.

• Techniques and methods to organize and manage a department.

• Principles and practices of health care service delivery, managed care, health care systems, and medical administration.

• Appropriate techniques to serve diverse social and ethnic groups and to communicate effectively with them.

• Principles and techniques of effective supervision, including training and evaluation of subordinates.

• Systems and procedures to efficiently operate the enrollment process and promote a high rate of member choice of health plan.

• Medi-Cal, Medicare, Healthy Families, and Medi-Cal/Medicare Program services, regulations and benefits, including State and Federal standards and regulations for member and provider rights and responsibilities.

• Personal computers, keyboarding, and appropriate software to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

• Knowledge and understanding of covered benefits specified in company contracts.

• Principles and practices of the managed health care systems, and medical administration.

• Appropriate techniques to serve diverse social and ethnic groups.

Additional Information

If you feel that you have the skills we require, please respond to this posting with your contact information and your resume in a Word document.  We look forward to hearing from you today!  

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