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Provider Services Supervisor-E2E
2 weeks ago
Role: PROVIDER SERVICES SUPERVISOR - E2E (IC)
Level: Supervisor (Blended/Hybrid Role)
Reporting Line: Provider Services Assistant Manager
Customer Type: Maxicare Providers and Members
Position Accountability Statement
The Supervisor plays a critical role in ensuring the smooth functioning of the overall Inpatient Team and has a direct impact on the efficiency of the overall Inpatient Team's processes. This will improve service delivery, uphold the quality and reliability of our services for Maxicare members, and support our Partner Providers.
Responsibility Highlights
The following broad responsibility statements are representative of the basic expectations about the role or function. Depending on business needs and exigencies, these responsibility statements may be modified. Critical to any leadership function is the need to demonstrate flexibility and agility in adapting to the changing requirements of the business.
- Minimal to zero supervision to review, evaluate, and process Letters of Authorization (LOA) following established procedures and professionally explain coverage and non-coverage details during Member's Availment Guide (MAG) discussion with admitted members.
- Analyze escalations and address concerns related to internal and external partners regarding eligibility, coverage (professional fees, miscellaneous &, etc.), and procedures within the standard turn-around time.
- Offer first-hand solutions for captured complaints and endorse them to internal departments (MRG, UEF, Sales) as necessary.
- Offer and steer members to the Maxicare Primary Care Networks, Preferred Partners, and Low-Cost Facilities, while highlighting Maxicare's exclusive benefits including recommended packages, and assisting members in understanding the available services.
- Works directly with the immediate superior in meeting the team and company's common goal. Prepare and submit reports ensuring that data is accurate and comprehensive.
- Execute various campaigns and tasks as needed during manpower shortages, business continuity planning (BCP) events, or when Service Level (SL) for other teams or sub-units are critically low, ensuring operations remain smooth and responsive to immediate demands.
Desired Skills And Competencies
- Strong Communication Skills: Strong verbal and written communication skills to explain coverage, handle inquiries, and liaise with various stakeholders effectively.
- Customer Service Oriented: Focus on providing excellent service, including handling inquiries and complaints with professionalism and empathy. Understanding Maxicare products and account's benefits and coverages.
- Problem-Solving Abilities: Capacity to assess situations and escalate complex cases appropriately, while providing first-hand solutions when possible.
- Organizational Skills and Technical Proficiency: Proficiency in managing multiple tasks, prioritizing effectively, and ensuring accurate documentation and filing of transactions. Experience with CRM systems (like Salesforce) and telephony systems (like Genesys) for managing customer interactions.
- Adaptability: Willingness to adjust to changing circumstances, especially during business continuity planning or manpower shortages.
- Confidentiality and Ethics: Commitment to maintaining patient confidentiality and adhering to ethical standards in all operations.
Professional Qualification
- A Bachelor's degree in a Healthcare or Medical-related field is preferred. Alternatively, candidates with at least 3 years of college education with a minimum of 2 years experience in Customer Service, or work experience in the medical field.
- Excellent verbal and written communication skills.
- Proficient in data entry and transaction processing with attention to detail.
- Proficient in using Google Applications (Gmail, GSheets, GSlides & etc.).
