Member Service Specialist Team Lead

Job Description

Job Description

Description :

POSITION TYPE : Hourly, Non-Exempt

BARGAINING UNIT : Bargaining Unit

WORK ENVIRONMENT : Hybrid

SEIU Healthcare IL Benefit Funds is a dynamic benefits administration organization committed to providing the highest quality health and retirement benefits in the most financially responsible manner, while always acting in the best interest of the union members.

The Fund serves over 20,000 union workers in the Nursing Home, Home Care, Child Care and Personal Assistant industries with delivery of health and pension benefits.

Our employees epitomize the Fund’s core values of quality service, interdependence, effectiveness, and accountability, and forge an alliance with one another to carry out our shared mission and common agreements for those we serve.

Position Summary :

The Member Service Specialist, Team Lead will be the first point of contact for all department team members and will work in a supportive leadership role to the Member Service Supervisor.

The Member Service Specialist is responsible for providing first level leadership and support to team members to ensure top quality service is provided to all plan participants.

The Member Service Specialist will de-escalate issues by identifying problems and providing direction for resolution by working interdependently with the Member Service Supervisor and stakeholders, as assigned.

The Member Service Specialist will serve as the department’s call center training coordinator, to train Member Service team members of all levels on best call center practices and guidelines, develop and update training manuals, assign tasks and monitor work as assigned by Member Service Supervisor and report on all call center activity and metrics, department production and service levels.

This position will represent the Member Service Department on the Team Lead Team, and will work with this cohort on assigned organizational initiatives.

As a Team Lead, the Member Service Specialist is responsible for project coordination within the department and communication on the status of strategic plan goals and initiatives.

Excellent communication skills, professional interaction with internal and external stakeholders, and the ability to provide leadership to support a team in providing excellent customer service is vital for this role.

The Member Service Specialist must have direct experience and comprehensive working knowledge of a call center environment, and support the Member Service Department’s operations and functions while working towards continuous process improvement.

The Member Service Specialist will use their expertise, analytical skills, and critical thinking to support the team in completing assignments, overseeing progress towards goals, coaching call center representatives as needed, performing duties in a timely manner, and representing the organization in a positive and professional manner.

The Member Service Specialist will be responsible for the following :

Key Duties and Responsibilities :

Call center quality assurance, call center data metrics and analysis, call monitoring, call coaching, call escalations, call center system monitoring, and process improvements

• Primary contact for escalations in a high call volume environment, with proven ability to assist call center representatives and plan participants in a variety of ways : in-person, over the phone and virtually
• Provide excellent quality service and act with professionalism towards all stakeholders, especially in service to union members
• De-escalate issues and assist with calls from plan participants, medical providers, vendors, and medical partners for all covered health plans
• Resolve open issues, whether received by call, voicemail, or in-person, within 24-hours of inquiry or with a clear plan of action to resolve and communicate progress and status
• Guide representatives to follow phone scripts, policies and procedures, and plan documents for first call resolution; log each inquiry into the benefit administration system and document the call type, referral code and thoroughly documented notes to support the call
• Monitor daily call volume and call times to ensure call center standards are consistently met
• Monitor calls and score service levels to ensure quality assurance levels are met
• Collect call center metrics and call survey data, and perform data analyses to identify trends and provide call center improvement recommendations
• Implement approved call center improvement initiatives
• Maintain knowledge of enrolling eligible members into the selected health plans based on the guidelines of the summary plan description with the knowledge of working with at least twenty-one (21) health plans
• Monitor and update project management software (Smartsheet) daily
• Coordinate, track, and report out on the progress of the department’s operational objectives and strategic plan goals
• Utilize quality assurance data management system to compile and track call center and member engagement performance at team and individual level, reporting identified strengths and areas of improvement
• Provide constructive feedback at the individual and group level, to call center representatives and supervisor, and recommend change proposals to enhance the overall call center performance
• Analyze call data and provide reports to management
• Update participant eligibility in benefit administration system and notify interdepartmental stakeholders as needed (cancellations, death notifications and enrollments)
• Participate in outreach and member engagement events, held in-person and virtually, to educate union members and employers on the plan benefits, eligibility requirements and enrollment processes
• Act as an eligibility liaison between Fund Office, Benefit Administration System, and Pharmacy Benefit Manager (PBM) to ensure enrollment status is accurate and up to date
• Act as training coordinator to train different levels of Member Service team members on call center best practices and policies and procedures, develop and update training manuals, assign tasks and monitor work under the direction of department supervisor, handle escalations, recommend final product and report all productivity to management
• Provide individualized and group level call center coaching to representatives for improved quality assurance
• Coordination and facilitation of various meetings including department meetings, interdepartmental meetings and training sessions, and meetings lead by the Team Lead Team cohort
• Attend and participate in various meetings, including monthly All Staff meetings, department meetings, training sessions, task force or committee meetings, and other meetings as deemed appropriate to share, discuss, and solution for question or error trends, as well as identify potential process improvements
• Create agendas and facilitate various meetings using the Purpose, Outcome and Process (POP) Model, while taking thorough notes
• Back-up all duties of the Member Service Assistant and Member Service Representatives as needed

Privacy and Security Responsibilities :

This position requires employee to handle Personal Identifiable Information (PII) and Protected Health Information (PHI) for our members.

You will be responsible and accountable for maintaining the confidentiality, integrity, and availability of all PII and PHI.

You must report any suspected identity or HIPAA violation or breach to our HIPAA Privacy and Security Officer.

Requirements :

Education Requirements :

• High school diploma or GED
• Customer service certification preferred

Job Requirements :

• 5+ years of call center customer service experience, preferably in healthcare insurance or benefits
• 3+ years as a call center trainer
• Ability to understand and provide basic to complex enrollment, benefits and eligibility information
• Ability to accurately type 40 words per minute
• Experience with desktop computers, laptop computers, printers, copiers, scanners, fax and other office equipment
• Intermediate Microsoft Word, Outlook and Power Point skills
• Advanced Microsoft Excel skills
• Analytical skills and creativity (data analysis, research, problem-solving and critical thinking)
• Quality Assurance experience in a call center environment
• Excellent written and verbal communication skills
• Customer service orientation with excellent interpersonal skills within all levels of the organization, including effectively communicating with peers, leads, managers, executives, and external partners
• Strong listener, attention to detail, and discernment
• Must be well organized with good time management and the ability to meet deadlines
• Must have the ability to work independently and within a team environment
• Strong accountability, cooperation in a team setting, with the ability to escalate and delegate as required
• Ability and willingness to assist in special projects and handle multiple tasks
• Valid Driver’s License and use of a personal vehicle for occasional travel

Preferred Skills :

• Bilingual in Spanish
• Team leader or some supervisory experience
• Two-year degree or some college preferred in business or healthcare management, or relevant field.
• Hybrid workforce experience, with in-person and remote work expectations
• Working knowledge of the basys / Bridgeway benefits administration system
• Experience with project management software, such as Smartsheet
• Experience working in a remote environment with laptop provided
• Experience with virtual conference software (Teams and Zoom)
• Awareness of social movements, labor movements, and political issues that impact the work and the organization

Physical Demands :

• Ability to carry and lift a minimum of 30 lbs.
• Ability to present in front of groups, in-person or virtually
• Work schedule flexibility to meet project demands
• Travel to off-site locations as needed, occasional weekends

Career Development & Continuing Education Opportunities : Yes

Benefits :

SEIU Healthcare IL Benefit Funds offers a comprehensive health benefit (medical, dental and vision coverage) for employees and eligible dependents, including no employee premium option for employee only;

competitive compensation; generous holidays and PTO policies; and a pension retirement plan.

Diversity creates a healthier atmosphere : SEIU Healthcare IL Benefit Funds is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

The SEIU Healthcare IL Benefit Funds vision is to create a more just and equitable society that fosters a lifetime of quality healthcare and financial security for all.

We hope that our social justice values and the responsibility we take to operate a socially conscious organization aligns with your professional desire to contribute and serve with purpose