Lead Customer Solution Center Navigator

　　Job Category: Customer Service

　　Department: Even MORE Outreach & Service

　　Location:

　　Los Angeles, CA, US, 90017

　　Position Type: Full Time

　　Requisition ID: 10648

　　Salary Range: $67,186.00 (Min.) - $87,342.00 (Mid.) - $107,498.00 (Max.)

　　Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.

　　Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

　　Job Summary

　　The Lead Customer Solution Center Navigator has lead responsibility in ensuring that member's coordination of care for complex cases are handled expeditiously according to regulatory and legislative requirements along with internal departmental procedures. Represent the member relations unit as a subject matter expert in the Manager's absence. The Lead Member Relations Navigators will assist with evaluation of the day-to-day operations. Lead responsibility for appropriate handling and triaging of complex cases, timeliness, language appropriateness, documentation accuracy, and internal quality assurance presented by all customers, members, ombudsman, Plan Partners, state contractors, advocates or other internal departments.

　　Duties

　　Take lead responsibility for all Line of Business complex cases and member benefit coordination; provide Member Relations Navigator direction and recommendation in the resolution of cases and coordination of benefits.

　　Conduct monthly case audit activities so staff is compliant and consistent with Policies and Procedures.

　　Update Manager with staff performance and assist with providing feedback when appropriate through detailed reports.

　　Assist Manager with the assessment and re-distribution of unit's workload. Help ensure that unit is in compliance with Policies & Procedure by establishing meaningful processes. Provide Manager with process improvement recommendations, ensure unit's compliance with HIPAA regulations relating to Protected Health Information (PHI).

　　Lead Navigators day-to-day activities, provides direction, process improvement recommendations.

　　Serve as a liaison for Call Center Management and Membership Accounting Management to ensure members' issues and needs are triaged, handled, and resolved.

　　Provide interdepartmental customer service as needed to address members issues.

　　Assist Manager to ensure the unit's operation runs efficiently.

　　Perform other duties as assigned.

　　Duties Continued

　　Education Required

　　Associate's Degree

　　In lieu of degree, equivalent education and/or experience may be considered.

　　Education Preferred

　　Bachelor's Degree

　　Experience

　　Required:

　　At least 4 years experience as a specialist in Customer Solution Center.

　　Minimum of 1-2 years of lead experience.

　　Skills

　　Required:

　　Experience working with firm deadlines, able to interpret and apply regulations.

　　Must be organized, detail oriented, able to exercise strong independent judgment; poses conflict resolution and persuasion skills.

　　A team player with excellent communication and presentation skills, able to work effectively with various internal departments/service areas, plan partners, participating provider groups and other external agencies.

　　Proficient in MS Office applications, Word, Excel and Power Point.

　　Requires strong knowledge of regulatory standards and claims processing.

　　Strong analytical, verbal, written and presentation skills.

　　Able to monitor and be compliant with strict regulatory deadlines.

　　Licenses/Certifications Required

　　Licenses/Certifications Preferred

　　Required Training

　　Physical Requirements

　　Light

　　Additional Information

　　Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

　　L.A. Care offers a wide range of benefits including

　　Paid Time Off (PTO)

　　Tuition Reimbursement

　　Retirement Plans

　　Medical, Dental and Vision

　　Wellness Program

　　Volunteer Time Off (VTO)