Call Center Member Advocate, Team Lead - The Health Plan

Position: Call Center Member Advocate, Team Lead - The Health Plan

Job ID: 148101

Location: US-TX-Bellaire

Department: Member Services - Inbound

Talent Area: Administrative Support

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 7a - 11p Monday - Friday; 7a -7p Saturday/Sunday

About Texas Children's Hospital

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.   You can also learn more about our amazing culture at


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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Responsibilities :

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


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