Customer Service Lead Representative

Mindlance is a company focused on providing support for Medicare Advantage and Prescription Drug Plans. They are seeking a Customer Service Lead Representative responsible for managing escalated complaints, ensuring compliance with CMS regulations, and collaborating with various teams to enhance operational processes.

Responsibilities:

• Thoroughly Investigate, resolve, and clearly document all CTM issues with priority to urgent and immediate need CMS requests, special cases and management requests from start to finish within the required timeframe
• Follow departmental policies and procedures and federal regulatory requirements when making decisions on member impact, compliance, and other implications
• Assist with new hire onboarding and training activity
• Back up to other team members who are out of the office or take on additional workload to ensure timely case closure
• Conduct peer-to-peer quality reviews, identify gaps and deficiencies, provide feedback and opportunities for improvement
• Identify system issues causing increased complaints and suggest improvements to prevent future occurrences
• Provide recommendations and collaborate with leaders and business partners in operating efficiencies
• Facilitate meetings with cross-functional business partners, as necessary, to properly address complex cases
• Provide expertise in triaging escalated sensitive/high risk issues from receipt to resolution
• Participate in weekend coverage rotation
• Serve as a super user for MHK/system testing
• Use critical thinking and problem-solving skills to identify root causes and adequate remediation of cases
• Collect information from cross-functional areas, consolidate, and strategically and carefully use judgment when preparing CMS case summaries and responses
• Work in conjunction with functional areas to review and improve methods, develop workflow, determine operational processes, and system enhancements to reduce administrative expenses
• Directly make updates to the CMS tool – HPMS
• Knows the formal and informal departmental goals, standards, policies and procedures, which includes familiarity of other departments within the organization that allows him/her to identify workflow efficiencies and process improvements across the organization
• Displays a positive attitude and escalates problems and issues to management as appropriate
• Ability to exercise administrative judgment and assumes responsibility for decisions, consequences, and results that have an impact on people, costs, and/or quality of service within the functional area
• Handles other duties and special projects as assigned

Requirements:

• Bachelor's degree preferred or 4+ years of experience in Medicare Advantage and PDP plans
• Knowledge in Medicare regulatory requirements
• Proficiency in CMS systems preferred and Microsoft Office (Excel, Word, Outlook)
• Strong verbal and written communication skills
• Strong critical thinking and analytical abilities to address complex issues
• Experience in the areas of customer service, grievances, and appeals highly preferred
• Proficiency with analytical tools, knowledge of data analysis methodology, strong communication skills and strong commitment to and affinity for delivering the highest level of customer service
• Ability to work a flexible work schedule that may include Saturday as a normal workday or a holiday weekend on a rotating basis
• Bilingual preferred