Job Description Summary
This position reports to the Manager, CCSB Administration. The Covered California for Small Business (CCSB) Supervisor I, Administration is responsible for all day-to-day operations for the perspective areas. This includes, but is not limited to, eligibility, enrollment, audits, COBRA administration and maintenance, and any billing and payment related functions performed for Pinnacle Claims Management Inc. (PCMI) and affiliated business lines with a specific focus on the CCSB contract with the State of California. This position will lead of team of Eligibility Specialists, level I, Level II, Level III plus a Team Lead, Administration to accomplish their goals.
Duties And Responsibilities
Department Operations
- Supervise all Administrative functions of the department, including new business, enrollment, carrier discrepancies, audits, and any finance-related issues.
- Responsible for completing all departmental functions while consistently meeting production service level agreements and quality standards.
- Monitor Eligibility team in Genesys to ensure we provide support to CCSB call center team based on business needs, ensuring efficient and effective customer service operations.
- Use data to measure the internal team's performance quality, accuracy, adherence to procedures, and service level agreements.
- Provide educational assistance to clients regarding administration functions, policies, and procedures.
- Provide timely and effective customer service to clients for requests, inquiries, or issues concerning enrollment and/or billing items on their account.
- Effectively communicate with internal departments and external vendors, brokers, or other business contacts to coordinate interrelated activities and resolve eligibility and/or billing issues as they arise.
- Implement strategies from your direct manager as well as senior management.
- Process-related verbal and written account inquiries on an as-needed basis.
- Become the subject matter expert for troubleshooting issues and escalations. Act as point of contact for client escalations.
Process Improvement & Cost Containment
- Support and assist the manager in the development of procedural strategies and operations processing including department policies and guidelines.
- Ensure all Standard Operating Procedures (SOP) are updated according to changes made in the process throughout the year.
- Regularly conduct surveys/polls amongst the audit team and processing team, either by email or during bi-weekly meetings, to foster a collaborative and malleable structure to cater to the needs of many different employees across different job titles.
- Identify inefficiencies within the established processes and suggest possible solutions to save time, reduce risk, and/or reduce expenses.
- Supervise enrollment audits of adds, terms, changes, new business, group setup, and call center transactions of all groups to ensure compliance with plan rules and guidelines.
- Review audit data and metric provided by the Audit team to measure the internal team's performance quality, accuracy, adherence to procedures, and turnaround time.
- Perform special project audits and reviews as requested by the management team.
- Maintain a minimum audit accuracy rate and meet productivity requirements for auditing.
- Effectively communicate with members and senior management as required to discuss and resolve audit findings and recommendations, with a focus on presenting trends and metrics to upper management to support departmental needs.
Management & Leadership
- Develop, manage, and lead a team of 3A+ self-accountable professionals.
- Develop a culture of authentic, personal accountability by modeling the behavior that defines it.
- Instill a culture of safety and expectation within your respective area/s.
- Require direct reports to hold themselves accountable to high-performance standards and personal conduct in a clear, helpful, straightforward way.
- Conduct one-on-one conversations with every direct report, focused on their 3A+ capabilities, impact, and effort.
- Make decisions impacting staff using the steps outlined in the "Outward Leadership" guide.
- Promote a culture of inclusion leveraging the "Outward Inclusion" principles.
- Identify and address training deficiencies, providing feedback to administration leads and promoting continuous improvement.
- Maintain and document the accomplishment and development towards future roles to consistently monitor the developmental plan for each team member.
- Regularly review and update the accomplishment and future role documentation to reflect current achievements and future development opportunities.
- Inspire proactive problem-solving and innovative thinking to enhance team performance and operational efficiency.
- Promote a culture of learning and growth, encouraging team members to seek feedback and implement constructive changes, and take ownership of their development, providing support and guidance as needed.
Other
- Maintain integrity and transparency in all tasks, ensuring alignment with team and organizational goals.
- Hold oneself accountable by taking ownership of actions, decisions, and their outcomes.
- Reflect on personal performance regularly, identifying areas for improvement and celebrating successes.
- Commit to continuous learning and growth, seeking feedback and implementing constructive changes.
- Serves as a representative of Western Growers/Pinnacle Claims Management (PCMI) displaying professionalism, knowledge, customer service, and discretion in all interactions with other members of the Western Growers/PCMI community and their customers.
- Utilize all capabilities to satisfy one mission - to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, be self-accountable, create a positive impact, and be diligent in delivering results.
- Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet.
- Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client data.
- Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit).
- All other duties as assigned.
Physical Demands/Work Environment
The physical demands and work environment described here represent those that an employee must meet to successfully perform this job's essential functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to move around the office. The employee is often required to use tools, objects, and controls. This noise level in the work environment is usually moderate.
Qualifications
- BA/BS degree in business, health care, or related field and/or three (3) to five (5) years' experience working in a related field preferred.
- In-depth knowledge of health care administration products and procedures including self-funded and fully insured products.
- Experience working with enrollment and billing systems in a health care operations environment preferred.
- Ability to establish priorities, multi-task, work in a fast-paced environment with tight deadlines.
- Intermediate to advanced computer skills with a variety of software applications.
- Excellent written and oral communication skills, to include modern business communications, formatting of professional letters, reports, and phone etiquette.
- Customer service oriented. Ability to work with clients and vendors and to build strong working relationships both within and external to the company.
- Ability to analyze and resolve technical problems and/or client inquiries as they arise.
- Knowledge of Health Insurance Portability and Accountability Act (HIPAA), Consolidated Omnibus Budget Reconciliation Act (COBRA), California-COBRA, Multiple Employer Welfare Arrangement (MEWA) and Employee Retirement Income Security Act (ERISA) regulations.
- Ability to work overtime based upon department needs.
- Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds.
- Home router with wired Ethernet (wireless connections and hotspots are not permitted).
- A designated room for your office or steps taken to protect company information (e.g., facing computer towards wall, etc.)
- A functioning smoke detector, fire extinguisher, and first aid kit on site.