Grievance Research Supervisor

OVERVIEW / GENERAL PURPOSE OF POSITION

Be a part of a team that transforms customer service into Customer Care by delivering an amazing experience. As a leader, you will focus on creating a culture dedicated to fostering an environment where compliance, quality and service excellence are your number one priority. Lead a team of up to 15 dedicated professionals towards performance excellence across all metrics through daily coaching, mentoring and evaluations. Serve as a point of escalation for inquiries requiring advanced expertise in order to resolve complex customer issues and ensure timely follow up and customer satisfaction. Must be comfortable operating in a fast paced, heavily regulated and high stress environment.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Supervise daily operations to guarantee success in meeting all CMS regulatory requirements, internal compliance, quality, and operational metrics
• Daily review and communication of results with individual team members in an effort to engage and provide guidance to achieve performance excellence that is aligned with CMS guidelines, Client SLA's and Convey standards
• Meet and/or exceed quality performance metrics through consistent quality monitoring and employee feedback
• Monitoring of productivity reports to ensure employee adherence to daily production expectations, quality standards in work product, and adherence to standard operating procedures for the department.
• Directly accountable for the accuracy of employee ADP records, payroll approvals, PTO, and scheduling
• Conduct coaching for QA while reviewing daily employee(s) performance and productivity.
• Coach and mentor team members and ensure quality feedback and continued development
• Establish mechanism for open communication and transparency with Grievance Manager and other department leadership which highlights areas of risk
• Support and communicate motivational campaigns for employees and achieve employee satisfaction
• Solicit feedback in open forums/huddles with employees and provide feedback to the Grievance Manager
• Escalate issues/risks that impact quality or performance relative to client expectations/SLA's in an expedient manner
• Prepare corrective actions and performance improvement plans in accordance with the Human Resource policies and procedures. Administer approved documents to employee(s).
• Promote performance excellence by demonstrating integrity, dedication, magnanimity and accountability
• Must drive team results to meet key performance indicators including but not limited to 100% CMS timeliness, 90% or better QA scores, 90% or better compliance scores, Client SLAs and overall quality and accuracy of resolutions provided to customers.

OTHER DUTIES AND RESPONSIBILITIES

• Responsible for compliance with all federal, state and local laws, rules and regulations affecting Company.
• Responsible for participating in quality assurance and compliance in-services, and continuing education activities as requested by the company.
• Responsible for performing other duties and responsibilities as required.

Requirements:

• Bachelor's or Associate's Degree in a related field from a four-year college or university, or an alternate "equivalency" of a combination of education and experience is sufficient.
• Number of years of leadership/supervisory/management experience (if any): 1-2
• Number of years of experience: 6-12 months successful experience in Grievance Analyst or above capacity working in a high volume Grievance department supporting Medicare Part D or Medicare Advantage plans.
• Demonstrated experience using workforce planning tools, knowledge of schedule adherence, exception tracking, and real time management
• Experience and knowledge working with QA platforms and strong coaching effectiveness acumen developing high caliber performing teams

Knowledge, Skills, and Abilities:

• People and Team
  • Leader who can influence and develop a team of dedicated care professionals and ensure they consistently meet performance metrics as established by department
  • Highly skilled in building a team of highly productive advocates through coaching team motivation
  • Ability to create and execute on action plans that are measurable with strict attention to detail and continuous follow up
  • Must have exceptional interpersonal, verbal, and written communication skills, and a high degree of emotional awareness in order to communicate effectively with varying personalities with the core goal of employee satisfaction
• Customer Focus
  • Ability to solve problems - Must love and have a passion for customer service with excellent listening skills, demonstrate empathy and the ability to educate customers
  • Must be a data driven decision maker utilizing tools and reports readily available and intermediate skills/knowledge with Microsoft Office (Excel, word, and Outlook)
  • Great sense of urgency proactively identifying and communicating trends where deviation to forecasts are imminent
• Culture
  • Understands and fosters our mission, vision and values of Integrity First, Inspired Team Work, and Compliance Matters
  • Must have an energetic presence – delighting customer and employees through written and face to face communication
  • Self-motivated, confident, reliable and commitment to customer satisfaction
  • Ability to interact professionally and maintain effective working relationships with superiors, coworkers, customers, and others