Job Description

Payroll Title:
MGD CARE SPEC 2
Department:
PHSO - MSO
Salary Range
Commensurate with Experience
Worksite:
Remote
Appointment Type:
Career
Appointment Percent:
100%
Union:
Uncovered
Total Openings:
1
Work Schedule:
Days, 8 hour shifts, Monday - Friday

As a federally-funded institution, UC San Diego Health maintains a marijuana and drug free campus. New employees are subject to drug screening.

#116252 Managed Care Customer Service Supervisor - Remote

Filing Deadline: Thu 5/26/2022

For the safety and well-being of the entire university community, the University of California requires, with few exceptions, that all students, faculty and staff be vaccinated against the COVID-19 virus and influenza before they will be allowed on campus or in a facility or office. For more information visit: Flu Vaccine Mandate / COVID Vaccine Policy

UCSD Layoff from Career Appointment: Apply by 05/16/22 for consideration with preference for rehire. All layoff applicants should contact their Employment Advisor.

Special Selection Applicants: Apply by 05/19/22. Eligible Special Selection clients should contact their Disability Counselor for assistance.

Candidates hired into this position may have the ability to work remotely.

DESCRIPTION

Reporting to the Contracting/Provider Relations/Customer Service Manager, the Customer Service Supervisor will oversee day-to-day operations of the PHSO Managed Care Customer Service department and Claims Customer Service staff.

In addition to performing all tasks and functions of a Customer Service Representative at the EXPERT level, this position will have direct supervision of the Managed Care Customer Service team and Claims Customer Service staff, including but not limited to: hiring and onboarding of new staff, annual performance evaluations, training and monitoring of department personnel to ensure compliance with department and organizational standards, managing high-level and escalated calls from health plans, members and internal/external providers, and serving as primary point of contact for the Organization's dedicated ACO/Internal Employee customer service phone line.

In collaboration with the Contracting/Provider Relations/Customer Service Manager, utilizes his/her experience and industry knowledge to assess, identify and implement "best practice" solutions for a broad scope of operational, system and program requirements. Maintains extensive knowledge of current healthcare and HMO administration policies and regulations, including Plan benefit interpretation, utilization policies, access methods, enrollment criteria and guidelines, billing, claims policies, and complaints, appeals and grievance procedures. Effectively communicates with all levels of audience in order to respond to inquiries and resolve issues to the highest degree of customer satisfaction.

MINIMUM QUALIFICATIONS

  • Six (6) years of related experience, education/training in Managed Care Customer Service and exposure to claims, OR a Bachelor’s degree in related area plus two (2) years of related experience/training in in Managed Care Customer Service and exposure to claims.

  • Demonstrated understanding of managed care contracting, contract review, tracking, and maintenance.

PREFERRED QUALIFICATIONS

  • Strong understanding of general HMO claims, UM, and benefits coverage protocols.

SPECIAL CONDITIONS

  • Must be able to work various hours and locations based on business needs.

  • Employment is subject to a criminal background check and pre-employment physical.


Job offer is contingent on successful engagement in the UC COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

UC San Diego Health is the only academic health system in the San Diego region, providing leading-edge care in patient care, biomedical research, education, and community service. Our facilities include two university hospitals, a National Cancer Institute-designated Comprehensive Cancer Center, Shiley Eye Institute, Sulpizio Cardiovascular Center, the only Burn Center in the county, and and dozens of outpatient clinics. We invite you to join our team!

Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached.

UC San Diego Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity or sexual orientation. For the complete University of California nondiscrimination and affirmative action policy see: http://www-hr.ucsd.edu/saa/nondiscr.html

UC San Diego is a smoke and tobacco free environment. Please visit smokefree.ucsd.edu for more information.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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