Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer.  All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion:  PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

Responsible for managing the Customer Service team responding to member and provider inquiries through phone, email, and walk-in. Ensure service metrics including call answer speed, service levels, and abandonment rates meet PacificSource standards and contribute positively to member and provider satisfaction. Represent the Customer Service function as part of the PacificSource operations team. Participate in strategic and long range planning representing the needs and considerations of Customer Service.

Essential Responsibilities:

Responsible for accurate customer service responses. Ensure accurate information is provided to members and providers. Measure and manage quality of call responses based on standards for accuracy, first call resolution, and courtesy.Identify root causes for customer complaints and address accordingly.Assist with high-level resolution of non-routine customer inquiries and complaints for all customers. Participate in resolution of member and provider customer service and/or claim issues. Consult with other departments and/or qualified staff as needed to resolve customer requests for adjustments to payments and for reconsideration of denied claims.Develop and implement process and procedures to improve operational efficiency. Improve use of web self-service tools.Develop, administer, and report service quality indicators for the department and each team under supervision.Work with internal departments and personnel to facilitate excellent service for PacificSource customers. Work cooperatively and in the best interest of all customer groups and take a proactive approach to ensure quality service.Responsible for process improvement within Customer Service Department and working with other departments to improve interdepartmental processes to improve service levels, customer satisfaction, call volumes, and efficiency.Responsible for apprising other departments of internal and external service related issues that may impact the organization and take appropriate action to incorporate changes into the day-to-day operations of the Customer Service Department.Act as a liaison with all PacificSource departments and staff regarding customer service.Work closely with staff in other departments, such as Claims, Health Services and Sales on updating policies and procedures for member, group, and provider services.Develop a strong understanding of Facets customer service modules as well as claims and provider modules. Identify changes in Facets configuration, workflow and security needed to improve service.Responsible for hiring, staff development, coaching, performance reviews, staff corrective action and termination of employees. Provide feedback, including regular one-on-ones and performance evaluations for direct reports.Actively participate as a key team member in company Managers/Supervisors meeting.Actively participate in various strategic and internal committees in order to disseminate information within the organization, represents company philosophy, and preserves visibility within the community.Ensure accurate representation of benefits, enrollment, and coverage information.Establish Customer Service Department policies and practices and develop efficient/effective procedures.Responsible for oversight, management, development, implementation, and communication of department programs.Develop annual department budgets. Monitor spending versus the planned budgeted throughout the year and take corrective action where needed.Coordinate business activities by maintaining collaborative partnerships with key departments.Responsible for process improvement and working with other departments to improve interdepartmental processes. Utilize lean methodologies for continuous improvement. Utilize visual boards and daily huddles to monitor key performance indicators and identify improvement opportunities.

Supporting Responsibilities:

Serve on various inter-office committees as required or needed. Document and report anypertinent communications back to team leaders and/or team members.Meet department and company performance and attendance expectations.Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.Perform other duties as assigned.

Work Experience: Minimum of 2 years experience in customer service operations required with a preference for 5+ years. Health insurance experience and advanced skills in medical terminology, CPT / ICD-9 coding preferred. 2-4 years of management experience as an effective and responsive leader preferred.

Education, Certificates, Licenses: Requires high school diploma or equivalent. Bachelor’s degree preferred.

Knowledge: Ability to gain thorough understanding of PacificSource products, plan designs, provider relationships, and health insurance terminology. Basic understanding of claims processing system and operation. Consistently helpful, confident, and pleasant with all types of customers, both internal and external. Relationship skills and leadership qualifications. Ability to clearly communicate with co-workers and takes proactive, as well as responsive, action to ensure good service. CPT/ICD-9 coding and medical terminology experience or education preferred. Ability to read and understand health contract and benefits language. Ability to work under time pressures and deal with difficult situations. Ability to define and prioritize problems and manage workload without direct supervision. Ability to read and understand health contracts and benefit language.

Competencies

Building Trust

Building a Successful Team

Aligning Performance for Success

Building Partnerships

Customer Focus

Continuous Improvement

Decision Making

Facilitating Change

Leveraging Diversity

Driving for Results

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.

Skills:

Accountable leadership, Collaboration, Communication, Data-driven & Analytical, Delegation, Listening (active), Situational Leadership, Strategic Thinking

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

We are committed to doing the right thing.We are one team working toward a common goal.We are each responsible for customer service.We practice open communication at all levels of the company to foster individual, team and company growth.We actively participate in efforts to improve our many communities-internally and externally.We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.