Manager Member Services - TEMPORARY

Manager Member Services - TEMPORARY

Oversees the daily operations of the local Member Services department responsible for responding to inquiries by health plan members. Supervises staff to ensure adherence to proper member service procedures and service level requirements in accordance to regulatory laws. Investigates causes of member inquiries and complaints.

Essential Responsibilities :

• Manages the day to day local Member Services operations including face-to-face customer interactions, complaint and grievance processing, and supervision of staff. Facilitates the effective and timely response to member inquiries, the resolution of member complaint and grievance cases. Ensures regulatory requirements and internal departmental standards are met.
• Monitors and analyzes causes of member complaints and inquiries. Monitors service levels. Oversees the work product of the staff to ensure the consistent and timely response and handling of member complaints and issues within regulatory requirements.
• Recommends, develops and participates in the implementation of action plans aimed at improving service delivery and promote member satisfaction and retention. Recommends goals, objectives, policies and performance standards.
• Educates and coaches staff and staff members in assigned local facilities regarding regulatory compliance issues. Coaches a professional staff in identifying, addressing, and resolving select member-provider and member-system conflict in order to prevent professional liability, reduce organizational risk and retain satisfied members.
• Identifies, develops and conducts training for staff members and other medical center department members regarding regulatory changes based on a review and analysis of customer contact data and audit trends.
• Represents the organization to external clients, including regulatory agencies, employer groups, and potential customers in the resolution of high-profile cases in support of maintaining business partnerships.
• Serves as a resource in areas that require customer service expertise. Advises and coaches Medical Center administrative staff members with issues regarding customer service strategies.
• Interviews and recommends candidates for employment and termination.
• Conducts performance evaluations and salary reviews for assigned staff.

Basic Qualifications :

Education :

Additional Requirements :

Preferred Qualifications :

Notes :