Supervisor(a) del Centro de Llamadas de Manejo de Primas

Supervisor(a) del Centro de Llamadas de Manejo de Primas

Regular

Exempt

GENERAL DESCRIPTION:

The Premium Management Call Center Supervisor oversees the daily operations of the Call Center Unit, ensuring that all team activities comply with established service, quality, and operational standards, as well as regulatory agency requirements. This role is responsible for managing the completion of corrective action plans and overseeing the processes for collecting, validating, and analyzing data associated with projects assigned to the unit. The Supervisor ensures operational accuracy, promotes continuous improvement, and supports the achievement of departmental performance goals.

ESSENTIAL FUNCTIONS:

• Develops together with the leader unit, the operational strategy and annual work plan for the Call Center, ensuring alignment with service, quality, and compliance standards.
• Monitors and follows up with the team on all assigned referrals related to Premium Management activities—such as ADS (Alternate Data Source), CHRA (Consumer Health Risk Assessment), and EDS (Encounter Data System) referrals—ensuring timely, accurate, and compliant processing according to established procedures.
• Monitors and follows up with the team on all assigned referrals related to HEDIS (Healthcare Effectiveness Data and Information Set), STARS (the CMS Five-Star Quality Rating System), and SNP (Special Needs Plans), ensuring timely, accurate, and compliant processing according to established procedures.
• Oversees communication with providers and members, ensuring consistent adherence to service-level expectations.
• Ensures compliance with regulatory requirements, internal procedures, PHI (Protected Health Information) protection standards, and quality metrics.
• Conducts quality audits and provides ongoing coaching, feedback, and training to assigned employees.
• Prepares, analyzes, and presents operational performance reports (daily, weekly, and monthly).
• Identifies risks, operational gaps, and opportunities for process improvement; collaborates with leadership to implement solutions.
• Coordinates with Information Systems and other departments to request system access, equipment, and technical support.
• 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, preferably in Business Administration or Health Services Administration. At least one (1) year of experience in customer service, preferably in healthcare facilities, medical offices, or medical plans. Knowledge of medical billing claims analysis, and/or ICD-10 coding is preferred. This includes one (1) year of experience supervising personnel.

OR

Education and Experience: Associate degree or at least 60-64 college credits. At least three (3) years of experience in customer service, preferably in healthcare facilities, medical offices, or medical plans. Knowledge of medical billing claims analysis, and/or ICD-10 coding is preferred. This includes one (1) year of experience supervising personnel.

“Proven experience may be replaced by previously established requirements.”

Certifications / Licenses: A valid Certification in Clinical Coding, such as Certified Coding Associate (CCA), Certified Coding Specialist (CCS), or Certified Coding Specialist-Physician Based (CCS-P), or Certification in Medical Billing and ICD-10-CM Course is preferred.

Other: Availability to work extended hours, including weekends and holidays if necessary. Proficiency in intermediate Excel and PowerPoint is required. Knowledge of the Alvaria Call Center System is preferred.

Languages:
Spanish – Intermediate (comprehensive, writing and verbal)
English – Intermediate (comprehensive, writing and verbal)

“We are an Equal Employment Opportunity Employer and take Affirmative Action to recruit Protected Veterans and Individuals with Disabilities.”