The Regional Manager manages the daily operations of the assigned region ensuring operation goals and time lines are met, Coordinates the workload of the Medical Advisors, oversees teams ( Regional and Night Shift) performance and performs quality control audits in order to guarantee high level of accuracy, cost control and customer service.
- Revise daily departmental priorities, assigns resources and create work schedules accordingly. Maintain appropriate staffing level, supervises the daily activities and prioritizes work load of Medical Advisors so daily/weekly departmental deadlines are met, and we are also consistent with the MST (nigh shift)’s services as during regular office hours.
- Measures team member’s performance against key performance indicators. Evaluates and performs performance feedback while taking appropriate actions necessary to maintain optimal performance including disciplinary actions as required. Conducts employee performance evaluations for company’s annual/mid-year performance appraisals. Provide management and professional guidance to team members through regular one on one meeting, regular team meetings, and performance goals.
- Implements and carries out the progressive disciplinary process when appropriate as per established guidelines and policies. Enforces all company and departmental policies.
- Manages time and attendance for direct reports. Monitors and reviews reports for extra hours worked.
- Trains and motivates new and existing staff for the effective administration of the department and ensures team members are taking proactive actions to resolve deficiencies in order to ensure the best level of service is being delivered both internally and externally.
- Completes basic quality control audits that allow review of at least 5% of the activities completed by the team (authorization letter, E-mails, calls, notes quality).
- Ensures cases are solved timely in compliance with policy and company provisions. Manages escalated cases up to resolution working directly with various departments, providers, customers and agents as necessary. Escalates cases to Head of MST as needed.
- Delivers training with agents based on requests from the Sales Department.
- Approves cases that should be handled as “Big claims”.
- Ensures claims pending doctor review (PDOC) are completed timely and with high level of quality.
- Approves the intervention of local auditors to evaluate complex cases. Identification and escalation of potentially fraudulent activity identified at any time of the evaluation process.
- Monitors feedback from Customer services and Resolution Team area in order to enhance team performance and determine areas of improvement or training.
The Ideal Candidate
- Medical graduate with at least five (5) years of experience in the medical or insurance field and at least two (2) year practicing medicine is required.
- Minimum of 3 years’ experience in a customer service environment is required.
- Minimum 3 – 5 years of experience handling and resolving medical complex cases is required.
- Bilingual English / Spanish with the ability to write correspondence and verbally respond to inquiries and questions in both languages is required. Additional ability to communicate in other language is a plus.
- Knowledge of commonly-used insurance concepts, practices, and procedures is required
- Excellent communication skills
- Good analytical and problem-solving skills sufficient to identify issues and assess problems through resolution.
- Basic knowledge of MS Office suite including word., Outlook and Excel to create correspondence.
- Multi-cultural experience is preferred.
- Experience in a supervisory, management or leadership role within a team environment is preferred.
- Excellent customer service and sound interpersonal skills to appropriately handle escalated issues.
- Excellent organizational, time management, prioritizing and multitasking skills in order to mange team’s workload.
- Demonstrated initiative, flexibility and ability to embrace and drive change.
- Cross cultural experience is preferred.