Call Center Member Advocate, Team Lead - The Health Plan

Texas Children's Hospital - Bellaire, TX4.3

30+ days agoFull-time
We are searching for a Call Center Representative Team Lead – someone who works well in a fast-paced setting. In this position, you’ll be responsible for being the first point of contact for assistance or information regarding eligibility, benefits, authorizations, claims, referrals and/or any other Member/Provider needs; assist and advocate for Members and/or Providers throughout the complaint and appeal process, and to assist Members with timely appointment scheduling. This role will primarily be responsible for possessing knowledge and understanding of the organization's processes, policies and procedures in order to investigate, resolve and/or facilitate resolution of simple to moderately complex issues and/or questions reported by Texas Children's Health Plan (TCHP) members, prospective members, healthcare providers, or other entities relating to TCHP Managed Care Organization.

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Job Duties & Responsibilities

Supports the Contact Center’s daily operations
Solves problems proactively and provides timely resolution to complex issues referred by Call Center Representatives
Identifies the most appropriate course of action for problem resolution and effectively communicates the plans to those impacted
Ensures team members have the necessary tools and information to perform their job
Handles difficult callers; provides timely assistance and intervention with problem calls
Addresses challenging customers and problems that require escalation outside the department
Provides management support to frontline representatives
Conducts and/or participates in new-hire interviews
Conducts coaching sessions and participates in Call Center Representatives performance review to identify opportunities and recognize positive behaviors
Monitors and documents representatives’ performance results
Identifies team and individual training needs and work with the Call Center Educator to develop plans for immediate and long-term performance improvements
Answers Member Services Representatives’ questions related to policies and procedures or use of desktop systems and tools
Monitors real-time queue and adherence reports to ensure service level and response time objectives are met; oversee real time escalation plans
Maintains visibility to team members
Rounds routinely to perform live monitoring of Call Center Representatives and aids those challenged with call adherence
Conducts group training sessions and the dissemination of information to team members
Leads and motivates team members to attain team and call center goals
Performs the work of Call Center Representatives during peak periods or staff absences
Collaborates with Claims, Eligibility, Provider Relations, Business Operations, and other Health Plan departments as needed to resolve member and/or provider issues
Conducts initial and on-going system training for Call Center Representatives
Conducts one-on-one system applications training for new Call Center Representatives assigned to the team; systems include, but not limited to the Cisco Agent Desktop, Cisco Quality Management System, TouCHPoint (the claims and eligibility system) and MACESS (contact documentation system)
Conducts system testing and reviews upgrades
Trains staff on functional changes resulting from upgrades
Responds to internal system trouble notifications and if necessary, coordinate the involvement of other departments to facilitate problem resolution
Serves as a continual resource for team member questions, concerns, etc.; viewed as being a primary available and approachable resource to team members
Fosters relationships amongst peers and internal departments to aid in collaborative discussions and workgroups to achieve business objectives; develop or refine processes and systems
Facilitates meetings to share and encourage learning from each other
Serves as an informal workforce leader
Serves as initial point of contact for all issues regarding schedules
Confers with Workforce Management on staffing and appropriately processes time off and updates the calendars
Maintains Call Center Representatives’ schedules for breaks and lunch
Rotate the 9-6 shifts to ensure Member Service Representatives and Call Center Representatives receive management support during center hours of operation
Runs weekly and monthly Agent Summary Reports to ensure Key Performance Indicators are met for Member Service Representatives and Call Center Representatives
Creates reports to aid in communicating performance trends
Contributes to monthly Management Reports which details team’s activity and performance for the month
Deploys cross functional communication and planning across all LOS (lines of service) to use resources/staff to aid in achieving key business objectives
Manages up Responsible for identification of stellar employee’s performance overtime and promoting promote employees’ performances accordingly
Participates in quality initiatives and performance management
Participates in performance reviews and conducts team meetings
Reviews and assesses Call Center Representatives’ documentation of customer contacts
Monitors Call Center Representatives calls and performs quality management review on randomly selected calls
Assists Manager in identifying opportunities for process and service improvement initiatives
Participates in the development and implementation of action plans
Conducts telephone-based surveys regarding customer satisfaction within Member Services
Facilitates and participates in Quality Management calibration sessions
Engages in one on one phone-based Member education and communications
Counsels health plan Members who are identified as non-compliant, make inappropriate use of health services, abusive, fail to keep scheduled appointments, etc
Participates in Activation Teams, Special projects or other committees identified, for the department
Identifies trends and process opportunities based on customer contact that may require review and modification to the current workflow or creation of a new flow/policy and procedure
Holds employees accountable for abiding by all TCH and TCHP policies and procedures
Skills & Requirements

H.S. Diploma or GED required
4 years of experience in customer service within managed care or insurance industry is required
4 years of experience working in a call center within any industry is required
Bachelor’s degree may substitute for two (2) years of required experience
General knowledge of the health plan’s operations, claim and eligibility systems, claim processing, and health care benefits
Knowledge of Texas Department of Insurance requirements for the handling of Member complaints and appeals
Knowledge of managed care, Medicaid, call center desktop support applications, customer relations techniques and general computer literacy
Benefits, claims processing or membership knowledge is preferred
The ability to work well with the public and adopt a customer perspective and work well individually and in a team environment
Effective interpersonal skills and phone etiquette are required
Strong verbal communication skills
Good listening skills
Knowledge of medical terminology
Problem identification and problem-solving skills and able to multitas

Company Profile
The Texas Children’s Hospital system is the largest pediatric integrated care system, and is an industry leader in pediatric population health. Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children and pregnant women. We are an Integrated Community System providing holistic care that empowers families to live healthier lives.

Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area. Currently, the Health Plan serves more than 450,000 members across three state territories (Harris, Jefferson, North East), who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals.

To join our community of 13,000 dedicated team members, visit for career opportunities.

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