Manager, Member Services - Hybrid



Duties: To manage a high performance, culturally sensitive and competent customer service Call Center that supports a rapidly



growing, diverse membership and provider community and an expanding portfolio of health plan options. To evaluate staff



development, customer service results and operational processes in order to ensure excellence in service, customer



satisfaction, and compliance with accrediting and regulatory agencies. To collaborate with counterparts within the Health



Plan to initiate and support organization wide performance improvement initiatives.



To manage a high performance, culturally sensitive and competent customer service Call Center that supports a rapidly



growing, diverse membership and provider community and an expanding portfolio of health plan options. To evaluate staff



development, customer service results and operational processes in order to ensure excellence in service, customer



satisfaction, and compliance with accrediting and regulatory agencies. To collaborate with counterparts within the Health



Plan to initiate and support organization wide performance improvement initiatives.



Coordinate efforts of department to develop and implement policies and procedures for provision of improved or new



services



Perform 24 hour on call duties as required



Completes timely performance appraisals for direct reports



Assures that new staff attends hospital orientation within 30 days of employment



Reports financial performance on a monthly basis



Develops and modifies job descriptions as necessary



Prepares and submits annual capital and operating budgets



Conducts appropriate investigations and follows-up on individual and patient complaints



Submits performance planning documents, ongoing planning materials, action plan and department goals

*This position will manage all MS regulatory/compliance (Policies and Procedures, reporting, report auditing, etc.) tasks, lead MS projects, manage the relationships that we have with our vendors (e.g. weekly touch base meetings, escalations, vendor communication, etc.).



*The candidate must be flexible to work any schedule during our hours of operation of 7a 7p M-F with occasional weekend support, as needed.



*On-site during the training period, which is approximately 4-6 weeks. Hybrid schedule opportunities will be determined based on business needs and discussed with the candidate post training.



Skills: Required for completely satisfactory performance in this job is industry knowledge specific to the market served by the



Health Plan -- managed health care.



Must have understanding of a Call Center business environment, tools and terminology; knowledge of claim processing and



claim systems, provider contracting, health care benefits, and how Health Maintenance Organizations work.



Preferable to have knowledge of Texas Department of Insurance requirements for the handling of Member complaints and



appeals.



Required for completely satisfactory performance in this job is the ability to demonstrate and act on an understanding of



the collective concerns of internal and external customers; demonstrate an understanding of how the parts of a problem



are related and interact in order to create an outcome; motivate employees through personal example; display effective



coaching and interpersonal skills; display effective problem-solving skills, including the ability to resolve conflicts,



troubleshoot issues and respond quickly to any situation.



Must be customer focused, including displaying behaviors such as follow-through and courtesy.



Must have the ability to communicate effectively and be adaptable.



Education:



Required- H.S. Diploma or GED



Required- 6 years experience as a Team Leader or Supervisor in Member Services, Claims Administration, or Provider Relations.



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