Supervisor Customer Service, Member Enrollment

We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.

We are hoping you will join us as a Supervisor Customer Service, Member Enrollment
and help shape the future of healthcare where you’ll be an integral part of our CS - Enrollment Reconciliation & Member Communications
team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Partial Telework
.

• If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.

The Supervisor Customer Service (Member Enrollment) is responsible for overseeing the day-to-day operations of the Enrollment & Reconciliation (E&R) department activities while supervising E&R staff. You will provide guidance to E&R staff on addressing and resolving member eligibility issues for Customer Service and other departments within Cal Optima Health. You will be accountable for staying current on the latest state and federal regulatory changes and updates.

In this role, the supervisor will be the point of contact for eligibility issues and will work closely with internal and external stakeholders for the resolution of member issues. Additionally, you will typically handle more difficult or complex questions and concerns regarding members' eligibility status. Together, we are building a stronger, more equitable health system.

• 50% - Program Support
  • Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
  • Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
  • Serves as the point of contact for eligibility issues and works closely with other Customer Service Supervisors, Information Technology (IT), Social Security Administration (SSA), contracted vendors, the Department of Health Care Services (DHCS), and/or the Center for Medicare & Medicaid Services (CMS) for member resolution.
  • Assists with developing, documenting and updating regulatory and departmental compliance desktop policies and procedures.
  • Maintains compliance by understanding state and federal regulatory guidance and abiding by policies and procedures (P&Ps) that meet all requirements.
  • Troubleshoots eligibility and enrollment issues for affected departments.
  • Resolves customer dissatisfaction through investigating, settling issues and resolving escalated and complex situations as needed.
  • Recognizes and resolves problems impacting department processes by collecting and analyzing information; communicates suggestions to management and develops/implements solutions as appropriate.
  • Partners closely with ITS to ensure accuracy of member eligibility and reporting.
  • Assists with providing education/orientation about Cal Optima Health benefits to both beneficiaries and community agencies as needed.
• 45% - Supervision
  • Assigns priorities for the team to ensure tasks are completed and performance goals are met, such as timely completion of CRM enrollment/disenrollment/change requests, timely processing of CMS issued transaction reply codes (TRCs)…