Manager Contact Center and Concierge Services-SWHR
Manager Contract Center and Concierge Services-Southwestern Health Resources-Clinically Integrated Network (SWHR-CIN)
At Southwestern Health Resources (SWHR), we believe healthcare can be more integrated, accessible, and affordable for all. Our purpose is simple yet powerful: to build a better way to care, together. SWHR is a patient-centered, clinically integrated network that brings together academic and community clinicians, researchers, hospitals, and ambulatory facilities. We partner with physicians to drive a new model of value-based, high-quality, data-driven healthcare—serving everyone in the communities we touch.
By combining the strengths of UT Southwestern Medical Center and Texas Health Resources, we’ve built the largest provider network in North Texas, giving our team members the opportunity to make a meaningful impact at scale. Healthcare in the U.S. is evolving rapidly, and SWHR is committed to leading that change—moving healthcare forward, together.
Position Summary
The Manager, Contact Center and Concierge Services, is accountable for direct management and oversight of telephonic and onsite interactions with members of client employer group health plans, members of plans directly administered by SWHR, client Human Resources employees, and healthcare providers participating in both the SWHR Network and with any client group networks as well as non-participating healthcare providers servicing members.
The position maintains a focus on service levels to benefit plan members, healthcare providers, and client administration as well as provides leadership with timely reports of quality metrics and key performance indicators.
· Work location: Farmers Branch, TX
Position Duties
Manages all aspects of contact center and concierge services including workforce management, call interactions, referrals to clinical programs, benefit navigation requests, appointment scheduling and support, outreach program initiatives, onsite engagement with client personnel, network provider searches, primary care physician selections, and provider network adequacy audits. Performs oversight of external vendors aligned with those functions.
Ensures appropriate and effective departmental goals and objectives are developed, implemented, and monitored in accordance with company standards as well as operational, contractual, and regulatory requirements. Manages all onsite and remote contact center and concierge services staff and represents department to leadership as well as other internal and external stakeholders.
Develops and manages regular monitoring audits of contact center telephonic interactions to ensure staff maintain exemplary professional conduct, demonstrate proficient knowledge of client plan benefits and products, and adhere to organization policies as well as any contractual and regulatory requirements. Tracks and trends the results of monitoring audits and addresses any needed system, process, or training remediations in a timely fashion. Provides leadership and clients with monitoring results and commentary.
Establishes department standards to ensure operational efficiency, productivity, and adherence to all client, contractual, and regulatory requirements. Prepares departmental daily and monthly operational, production, key performance indicator, client service level guarantee, and regulatory reports as required. Analyzes data to identify opportunities for process improvements. Provides leadership and clients with monitoring results and commentary.
Leads team in the research, resolution, and any required follow up of all inquiries and issues. Prepares detailed correspondence for external and internal entities as needed. Serves as key contact for client leadership and offers support as needed. Triages all escalated contact center issues, appeals, and grievances for clients, plan members, brokers, and healthcare providers.
Monitors operations and performance of external call center vendors handling the customer service function for client health benefit plans in order to ensure accuracy and production standards as well as contractual and regulatory requirements are met. Manages the function areas and staff which coordinate with and have delegation oversight of customer service operations.
Develops and maintains all department policies and procedures, desk level procedures, and workflows according to current business, contractual, and regulatory requirements; ensures the adherence to all such guidelines by both internal staff and external support vendors.
Responsible for department staffing and recruitment to ensure adequate coverage for current and projected work. Renders staff performance reviews and delivers timely, actionable, and meaningful feedback. Provides staff development and growth opportunities. Motivates subordinates, establishes teamwork, and builds employee and team morale.
Oversees the content and format of all department training materials. Responsible for new hire trainings and team refresher or update trainings. Oversees training of personnel to ensure they maintain a current knowledge base related to company products, networks, client groups, policies, and contractual and regulatory requirements.
Performs other duties and special projects as assigned.
Education
Bachelor's Degree Business Admin, Healthcare Admin, or related required, Or, Associate's Degree Business Admin, Healthcare Admin, or related with 7 years experience required. Or, H.S. Diploma or equivalent with 9 years experience required
Experience
5 years Healthcare (Health Plan or Health Provider) Customer Service and/or client engagement experience to include 2 years supervisory or leadership experience (with Bachelor's) required.
Or, 7 years Healthcare (Health Plan or Health Provider) Customer Service and/or client engagement experience to include 2 years supervisory or leadership experience (with Associate's) required. Or, 9 years Healthcare (Health Plan or Health Provider) Customer Service and/or client engagement experience to include 2 years supervisory or leadership experience (without degree) required
Skills
Firm understanding of all aspects of call center operations including personnel knowledge base and soft skills, workforce management, call coverage requirements, performance monitoring, call documentation, workflows, telephone queues, interactive voice response (IVR), reports, systems, dashboards, metrics, satisfaction surveys, telephony products and services, and artificial intelligence tools and configuration.
Conversant with various types of commercial and government health care benefit programs, employer group benefit plans, and benefit plan designs. Able to interpret and explain plan documents such as summaries of benefits and coverage, summary plan descriptions, group and individual policies, certificates of coverage, explanations of coverage, explanations of benefits (EOBs), and plan correspondence.
Strong working knowledge of provider network arrangements and reimbursement methodologies and of health benefit plan concepts such as limitations, exclusions, waiting periods, waivers, coordination of benefits, utilization counters, member and plan responsibilities, stop loss, subrogation, authorization and referral requirements, recoveries, and the appeals and grievances process.
Knowledgeable of and compliant with all relevant laws, rules, regulations and accreditation standards and requirements regarding health plan operations (ERISA, Department of Labor, HIPAA, Texas Department of Insurance, Centers for Medicare and Medicaid Services (CMS), URAC, etc.).
Ability to identify training and mentoring needs for department employees coupled with the necessary developmental and communication skills to design and provide the training.
Proficient with Microsoft Office: Excel, Outlook, PowerPoint, and Word; working knowledge of report writing applications such as Crystal Reports, Power BI, and Tableau.
Strong attention to detail with excellent analytical, proofing, problem solving, organizational, multitasking, and time management skills.
Self-motivated with confident decision-making abilities; able to focus in a fast-paced environment and manage complex projects within deadlines and budget.
Demonstrates excellent verbal and written communication skills as well as dynamic presentation skills.
Shows strong people focus with exemplary customer service and interpersonal skills; demonstrates excellent relationship and team building talent.
Travel Requirements
Local 20% Travel between SWHR locations and client sites as needed to perform assigned duties
Why Southwestern Health Resources
As a Southwestern Health Resources you’ll enjoy: comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.
Explore Southwestern Health Resources Careers for more information and to search all career opportunities.
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