Supervisor, Medicare Member Services

Job not on LinkedIn

🔥 12 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🟠 Senior

🔴 Lead

👻 Ghost score 10%

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WVU Medicine

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

WVU Medicine is a comprehensive health system affiliated with West Virginia University, providing medical services through a network of hospitals across West Virginia. The system includes notable facilities such as J. W. Ruby Memorial Hospital, WVU Medicine Children's, and various other regional medical centers. WVU Medicine offers a wide range of healthcare services, including specialized and advanced medical treatments such as robotic heart surgery. It's also involved in medical education, research, and community health initiatives, emphasizing a mission of delivering high-quality care to the communities it serves.

📋 Description

• Supervise and coordinate the daily operations and performance of a Medicare Member Services call center team • Provide leadership, coaching, counseling, recognition, corrective action, and operational oversight • Monitor call volumes, service levels, average speed of answer, abandonment rates, schedule adherence, quality, productivity, and other performance measures • Ensure accurate information is provided regarding Medicare Advantage and D-SNP benefits, eligibility, enrollment, claims, authorizations, provider access, pharmacy coverage, grievances, and appeals • Ensure compliance with CMS requirements, Medicare and Medicaid regulations, D-SNP requirements, HIPAA, organizational policies, and applicable state and federal regulations • Monitor calls, CRM records, and member documentation for accuracy, completeness, professionalism, and compliance • Identify training and continuing education needs; support onboarding, mentoring, and transition to independent call handling • Complete performance evaluations, reviews, one-on-one meetings, and employee assessments • Communicate benefit, process, policy, regulatory, system, and operational changes to staff • Oversee SharePoint and other approved systems for team resources and departmental documentation • Coordinate resolution of member issues with Enrollment, Claims, Pharmacy, Provider Relations, Care Management, Appeals and Grievances, Compliance, Quality, and Information Technology • Handle escalated member, provider, authorized representative, and internal staff concerns and facilitate timely, compliant resolutions • Identify and appropriately document and refer complaints, grievances, appeals, coverage concerns, and compliance issues • Work with the Manager or Director on departmental goals, performance standards, objectives, quality-improvement initiatives, and strategic priorities • Maintain confidentiality and protect personally identifiable information and protected health information • Review operational reports, quality findings, call-monitoring results, feedback, complaints, and compliance concerns to implement corrective or preventive actions • Manage employee schedules, attendance, timekeeping, paid-time-off requests, breaks, lunch adherence, and staffing coverage • Participate in recruitment, interviewing, selection, onboarding, and retention of Medicare Member Services representatives • Promote a professional, collaborative, inclusive, accountable, and member-focused work environment • Perform other duties as assigned

🎯 Requirements

• High school diploma or equivalent and three (3) years of experience working in a customer service call center environment and four (4) years of experience working in Medicare, Medicare Advantage, CMS, Medicaid, Dual Eligible Special Needs Plans (D-SNP), healthcare compliance, health plan operations, member services, or a related environment; OR associate’s degree and two (2) years of experience working in a customer service call center environment and three (3) years of experience working in Medicare, Medicare Advantage, CMS, Medicaid, Dual Eligible Special Needs Plans (D-SNP), healthcare compliance, health plan operations, member services, or a related environment • Strong knowledge of Medicare Advantage, D-SNP, Medicaid, CMS requirements, and health plan operations • Demonstrated ability to lead, coach, motivate, and develop employees in a fast-paced customer service environment • Ability to monitor and interpret call center performance metrics, quality results, productivity measures, and service-level data • Strong decision-making, problem-solving, critical-thinking, and analytical skills • Excellent verbal and written communication skills, including communicating complex healthcare, Medicare, and regulatory information clearly and professionally • Ability to sit, stand, walk, and use standard office equipment for extended periods • Standard office environment • Required schedule: 12:00 p.m. to 8:00 p.m., Saturday through Wednesday; schedule subject to change based on departmental and operational needs

🏖️ Benefits

• Full-time employment • 40 scheduled weekly hours