Operations Manager of Claims & Patient Services

About us:

We’re a unique organization. We help patients who need financial assistance every day. We make a difference. We change lives. Our vision is to see the day when no person goes without medication due to an inability to pay. Until then, we exist so that patients don’t have to miss taking their medication because of cost.

Every TAF team member plays an important role in helping our organization support our patients. We strive to do this in the most efficient, compliant and compassionate manner possible.

Summary of Position:

The Operations Manager, Claims & Patient Support, is responsible for the daily operations and management of all patient interactions with the TAF Contact Center, including telephone calls, online chat, emails, text messaging, and handling of reimbursements and claims. This role ensures efficient processing, a high level of customer satisfaction, and adherence to company policies and procedures. This includes providing direct leadership to the Patient Advocate and Claims teams and ensuring accountability for all aspects of Contact Center operations. This role drives service excellence, improves team member performance, and ensures that all Service Level and KPI goals are exceeded. This role involves supervising staff, managing workflows, and ensuring compliance with relevant regulations and company policies. Also responsible for building a culture of trust, where team members enjoy their work, have opportunities for growth and have fun.

Responsibilities:

The Operations Manager, Claims & Patient Services responsibilities include but are not limited to:

Service Level Achievement & Operational Management:

• Coordinate staff Resource Planning in partnership with HR and Workforce Planning to determine hiring needs and proactively to plan for forecasted seasonality.
• Manage daily operations, special projects, and strategic planning emerging risks.
• Adapt to unexpected volume spikes and manage schedule adherence to ensure service level agreements.
• Ensure that payroll records are accurate and approved by both team members and appropriate supervisor.
• Approve or deny PTO as driven by volume forecasts to provide adequate coverage.
• Prepare service center performance reports by collecting, analyzing, and summarizing data and trends.
• Maintain transparent communication by appropriately communicating organization information to team through department meetings, one-on-one meetings, appropriate email, chat and regular interpersonal communications.
• Assist in the preparation of reports for management, highlighting key metrics and performance indicators.

Performance Management & Continuous Improvement:

• Ensure smooth and efficient processing of all reimbursements.
• Identify and implement process improvements related to claims and reimbursement handling.
• Development of a Performance Management plan that includes motivational and corrective action processes to ensure continuous improvement. Coach and Counsel employees as required by the plan.
• Work with Supervisors and Team Leads to improve Patient Advocate, Claims Specialist and Claims Analysts performance and ongoing development. This includes ensuring that all members have monthly performance reviews that include coaching for quality, efficiency, schedule adherence and attendance, as well as career development action plans.
• Ensure that Claims Team handle reimbursement requests to the highest efficiency and settle payments within policy guidelines.
• Perform one-on-one mentoring sessions with Supervisors and Team Leads, discuss professional and personal development.
• Develop, maintain, and analyze of performance management reporting. Take appropriate action to ensure that challenges are addressed.
• Drive individual team motivation to improve performance through competitions, games and incentives.

Service Excellence & Quality Oversight:

• Partner with Operations and Quality Management to ensure effective monitoring scoring, and alignment of expectations.
• Establish and implement departmental policies, goals, objectives, and procedures as needed.
• Identifying, assigning, and coordinating expertise resources to assist in efficient case resolution.
• Handle escalated calls as needed in support of Supervisors, Team Leads, Patient Advocates, and Claims Analysts.
• Act as subject matter expert for Senior Leadership as needed to support TAF programs.
• Maintain professional and technical knowledge by tracking emerging trends in service center operations management.
• Partner with the Learning & Development department to develop and implement necessary on-going individual and group training sessions.
• Support organizational goals by taking ownership of new initiatives and exploring opportunities to add value.

Qualifications:

• Bachelor’s degree or equivalent work experience
• Experience managing Healthcare Contact Center or billing Operations, 3 years
• Working knowledge of Contact Center systems and processes.
• Experience working with Salesforce is highly preferred.
• Experience in processing patient reimbursements, medical or pharmacy claims
• Proven ability to improve Contact Center Performance
• Effective communication skills: written and interpersonal
• Ability to think creatively and apply knowledge to effective problem solving
• Ability to multi-task
• Experience in patient assistance or patient financial access programs

Benefits: At TAF, we’re proud to offer a competitive and comprehensive benefits package designed to support you both personally and professionally.

Highlights include:

• 401(k) Retirement Plan – Eligible after 90 days of employment, with TAF matching 100% of your contributions, up to 6%.
• Health, Dental, Vision, and Life Insurance – Coverage begins the first of the month after 60 days of employment. We offer three medical plan options, with two fully covered by TAF for employees and dependents. Additional coverage for your spouse, children, or family is available based on plan details.

TAF also provides dental, vision, life insurance, and other benefits in accordance with our summary of plan offerings.

We invest in our people because we know that when you’re supported, you do your best work.