Manager Member Services-Group/Major Market

Position Description

Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” 

This position is responsible for managing a team in providing quality service in response to Customer and Provider problems and inquiries in a timely, accurate, and cost effective manner. The Manager is responsible for the development and implementation of departmental goals and improved processing procedures, as well as directing the overall efforts of each employee in maintaining an efficient unit operation through motivating and counseling.

Responsibilities and Qualifications

• Assesses and monitors the overall inquiry processing operation through analysis of automated and manual reporting systems (e.g., Inquiry Control System, Telephone Quality Reports, Imaging, Work Management, MTM and inventory reports), takes action to ensure departmental/corporate goals are met, and determines personnel requirements necessary to provide quality, timely responses to inquiries. Monitors the ongoing effectiveness and development of the Inquiry Control System, and other automated systems. Coordinates with Telecommunications for the purchase of equipment and addresses recommendations and/or problem areas.
• Develops, implements, and monitors quantitative and qualitative criteria for evaluation of the department’s personnel and operation. Recommends and develops improved processes and procedures to monitor and meet departmental and corporate goals. Reviews all departmental performance appraisals and salary reviews prior to submitting to the Sr Director. Assists team in resolution of production, inquiry response, or personnel related problems. Develops skills of the team through discussion, instruction, and delegation of appropriate responsibilities. Resolves operational problems by investigating the problem and communicating with individuals and/or areas involved, determining appropriate actions to be taken to correct the problem, and communicating with and directing key individuals toward problem resolution.
• Assists team in preparation of annual budget and corporate plans to estimate resource expenditures required to meet departmental and corporate goals. Evaluates and monitors budget variances and provides explanations and recommendations to the Sr Director. Represents the department on various committees or task force projects as assigned. Reviews the development and implementation of ongoing departmental training efforts and recommends enhancements as appropriate. Performs research and analysis relative to current or future Customer Service functions and presents results and/or recommendations in written and statistical reports.
• Analyzes the effects of policy and procedure changes upon the department, Customers, and Providers and Groups. Makes recommendations for modifications. Communicates in written and verbal form to the marketplace, various Plan personnel, other Blue Cross and Blue Shield Plans, and government officials regarding Customer Service topics. Conducts periodic meetings of staff in order to address corporate, departmental and unit issues.

Knowledge:

• Knowledge of management techniques such as production planning and control, statistical analysis, problem solving techniques and human relations skills.
• Knowledge of corporate and departmental policies, organization, personnel procedures, and systems affecting Customer Service operations, as well as their relationship in servicing other areas of the Plan. Familiar with policies and procedures of Capital Blue Cross products, Government Programs, CMS, etc. in terms of benefits administration and billing procedures.
• Knowledge of corporate goals and the importance of adhering to standards established for the department. Familiar with the Inquiry Control System, Avaya, CentreVu and its application to Customer Service operations.
• Knowledge of management tools as aids in improving and controlling operations, such as automated telecommunications systems, information processing equipment, budget theory and application, Microsoft Word, Excel, Access, etc. Ability to analyze manual and automated processing problems and to design, develop and assist in implementing enhancements.
• Ability to effectively communicate in written and verbal form to varied audiences on both complex and simple issues. Ability to perform assigned tasks with minimal guidance.
• Ability to lead, motivate, appraise and develop personnel. Ability to plan, organize, delegate and prioritize work in order to maintain an overall efficient operation. Ability to coordinate and direct activities of each Unit to meet quality and quantity standards.
• Knowledge of Capital Blue Cross’ Human Resource policies and procedures.

Experience:

• 3 years of relevant customer service experience.

Education and Certifications:

• High school degree or equivalent.

Location: 

• This position is classified hybrid, which requires onsite work on Tuesdays and Wednesdays. 

Physical Demands:

• While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see.
• The employee must be able to work over 40 hours per week.
• The employee must occasionally lift and/or move up to 5 pounds.

About Us

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues, and be encouraged to volunteer in your community.  We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.