Supervisor I, Enrollment and Eligibility (51068)

Job Description Summary

The Supervisor I, Enrollment and Eligibility is responsible for all day-to-day operation for the Administration - Eligibility and Enrollment Department. This includes, but is not limited to, eligibility, enrollment, reinsurance and participation audits, COBRA administration and maintenance, and ACA processing functions performed in the Administration Department for Pinnacle Claims Management Inc. and Western Growers Administration Trust customers.

Duties and Responsibilities

Process Improvement/Management

• Responsible for set-up and maintenance of all WGAT and PCMI accounts. Supervision of all Eligibility and Enrollment functions in the Administration Team to include group set-up, enrollment, eligibility, and group eligibility audits.
• Responsible for successful completion of all departmental functions while consistently meeting production and quality standards.
• Implement strategies from your direct manager as well as senior management.
• Responsible for training and managing staff including both staff development and corrective discipline.
• Plan and execute work in a helpful and collaborative manner.
• Monitor and communicate to management processes deficiencies and recommended solutions.
• Monitor business needs and develop documented processes and procedures as needed to create and maintain effective and productive workflows.
• Process related verbal and written account inquiries on an as needed basis.
• Identify inefficiencies within the established processes and suggest possible solutions to save time, reduce risk, and/or reduce expenses.
• Create and document a minimum of one new Standard Operating Procedure (SOP) annually.
• Identify, initiate and implement at least one process improvement and/or innovation annually.

Customer Service

• Act as liaison with other departments to resolve Eligibility and Enrollment related issues (CCSB and Non-CCSB lines of business) and intra-company workflow issues.
• Provide educational assistance to clients relative to administration functions, policies and procedures.
• Serves as representative of Western Growers/Pinnacle Claims Management (PCMI) displaying professionalism, knowledge, customer service and discretion in all interactions with other members of Western Growers/PCMI community and their customers.

Management & Leadership

• Develop, manage, and lead a team of 3A+ self-accountable professionals.
• Develop a culture of real, 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 standards of, performance and personal conduct, in a clear, helpful, straightforward way.
• Conduct one-on-one conversations with every direct report, on a quarterly basis, focused on their 3A+ capabilities, impact, and effort.
• Make decisions and choices, impacting staff, by using the selection and hiring, clarifying roles and objectives, managing performance, correction & discipline and termination steps as outlined in the "Outward Mindset Skills for Leaders" guide.

Other

• 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, being self-accountable, creating a positive impact, and being 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 or requested

Physical Demands/Work Environment

The physical demands and work environment described here are representative of those that must be met by an employee to perform the essential functions of this job successfully. 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 plus six years' experience working in a related field or equivalent combination of education and experience 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.
• The ability to establish priorities, multi-task, work in a fast-paced environment with tight deadlines, work independently with minimal supervision and in a team environment.
• 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.