Supervisor(a) del Programa de Valor al Afiliado
Regular
Exempt
GENERAL DESCRIPTION:
Responsible for the unit's team members to resolve cases and complete reconciliations promptly and accurately.
Guarantees compliance with indicators established by the department, such as metrics, including achieving quality scores
and completing reconciliations.
ESSENTIAL FUNCTIONS:
Constantly monitors the volume of cases received in the unit, checking that the team's unit complies with established standards, and with the regulatory agencies documenting cases appropriately.
Guarantees processes are carried out by the performance, quality, and compliance parameters within the established deadlines.
Oversees unit inventories by assuring completeness of the records, requests, distributes, reviews, storage, and seizure of the applicable items.
Manages sensitive situations presented by customers with other departments and responds to internal inquiries from other departments. If necessary, escalate any situation with management.
Identifies issues and communicates them to upper management to develop and implement operational policies, reconciliation procedures, and processes. This proactive approach ensures the effectiveness of the program.
Prepares reports to analyze unit metrics. Monitors that the employees under their charge comply with the indicators, as established, such as productivity, quality of service, documentation of each case, request or question from customers were addressed and referred correctly, appropriately, and promptly, all cases should comply with established and approved procedures, reconciliations are accurate and completed daily.
Ensure that reconciliation processes and documentation meet audit requirements.
Proactively communicates findings or discrepancies found in reconciliations or data error reports to their management and provides recommendations for improvement.
Stay updated on industry trends and recommend improvements to reconciliation systems.
Supervises, monitors, trains, evaluates, and corrects personnel among others to comply with his/her role as a supervisor, to assure that his/her personnel fulfill their work plan and comply with their essential functions and that they behave following the policies, standards, norms, and procedures of the Company.
Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.
MINIMUM QUALIFICATIONS:
Education and Experience:
Bachelor's degree preferable in Business Administration, or related areas. At least three (3) years of experience performing duties of performance management programs. At least one (1) year of experience in supervising staff, preferably in the Health Insurance Industry.
"Proven experience may be replaced by previously established requirements."
Certifications / Licenses:
N/A
Other:
Availability to work rotating shifts, including weekends, and holidays.
Languages:
Spanish –
Advanced (comprehensive, writing and verbal)
English –
Advanced (comprehensive, writing and verbal)
"Somos un patrono con igualdad de oportunidad en el empleo y tomamos Acción Afirmativa para reclutar a Mujeres, Minorías, Veteranos Protegidos y Personas con Impedimento
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