Job Description

: Works closely with supervisors, trainers, and team member to ensure high quality service to customers by focusing on internal quality assurance within the operations phones teams. Catalyst for process improvements to gain efficiencies, save costs, and support Superior Service to customers. Schedule Monday- Friday 8am-5pm Job Essentials

1. Receives incoming calls from members, providers, facilities, employer groups, and other departments. Provides superior customer service that is consistent with policies, company values and quality standards.
2. Reinforces the organization\'s brand by being friendly, competent, a problem solver, and a good communicator.
3. Ensures the provision of Superior Service to customers through various continuous quality improvement efforts related to issues involving workflows, processes, training and documentation. Identifies service deficits and potential areas for improvement.
4. Advises supervisor of areas of improvements then discusses and creates action plans for improvement.
5. Coordinates with supervisor on any training issues identified through this process, including developing and/or delivering training to team members through various methods. Meets with team to discuss issues and educate for improvement. Maintains tracking records of issues and resolution.
6. Audits phone calls and educates team members on correct use of insurance plans, including coverage of benefits, utilization, and administrative guidelines. Assesses work styles, makes recommendations for changes to establish best approach in an effort to achieve improved call response and handling time, availability, and call flow to ensure the provision of Superior Service. Sets weekly goals for improvement and reviews results with supervisor.
7. Participates on quality committees to improve issues relating to workflow processes, training and documentation. May participate on committees to design and implement system enhancements and upgrades to ensure quality of associated workflow processes, training and documentation.
8. May perform system testing as needed when system updates or enhancements are created and implemented.
9. Ensures compliance of established policies, procedures and guidelines by running, reviewing and working with team members on several monitoring reports. Pulls reports to ensure accuracy of maintenance of customer history in member tracking, including correct use of codes and detailed comments and to ensure team jobs and assignments are completed.
10. Provides team support and expertise on subject matter. Assists team members to ensure timely resolution of phone call follow up items within team timelines and standards.
11. Communicates with team members to offer assistance in resolving claims issues that are past deadlines.
12. Takes supervisor calls when a supervisor is unavailable.
13. Develops and facilitates training related to workflow processes and procedures. Assists in the education of caregivers or HBS\' by answering questions regarding policies, procedures and guidelines, concepts and utilization and functionality of programs.
14. Attends team meetings and trainings as needed to stay current on policies, procedures and guidelines. Maintains current knowledge and is conversant on general plan design and modifications to provide accurate and appropriate information.




Minimum Qualifications

For SelectHealth positions:18 months of SelectHealth operations experience as a Health Benefits Specialist, Member Advocate, or Pharmacy Benefits Specialist to gain an expert level understanding of operations policies, procedures and guidelines while meeting performance standards. For Medical Group positions: 18 months of call center experience as a PSR in the Medical Group to gain an expert level understanding of operations policies, procedures and guidelines while meeting performance standards.

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Demonstrated intermediate skill in spreadsheets and word processing.

Preferred Qualifications

Demonstrated excellent interpersonal and communication (written and oral).
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Demonstrated the ability to balance daily tasks, mentoring, and assigned projects.
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Exhibits leadership skills by modeling strong work ethic, positive attitude, excellent communication skills, and positive interactions with peers, adherence to all policies, procedures and guidelines.
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Effective project and workload management skills with the ability to multitask.
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Analytical, detail oriented, and demonstrates initiative.
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Creative, motivated, enthusiastic, possess leadership qualities, and work well under pressure. Physical Requirements: Hearing, speaking, seeing, manual dexterity. Anticipated job posting close date: 12/03/2023 Location: SelectHealth - Murray Work City: Murray Work State: Utah Scheduled Weekly Hours: 40 The hourly range for this position is listed below. Actual hourly rate dependent upon experience. $19.08 - $29.04 We care about your well-being \xe2\x80\x93 mind, body, and spirit \xe2\x80\x93 which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged. Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers , and for our Colorado, Montana, and Kansas based caregivers ; and our commitment to diversity, equity, and inclusion . Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.