The Member Services Manager should possess strong supervisory/leadership skills including planning, organizing, directing, and coordinating the activities of Providers, Member Advocacy and Customer Service. Requirements include a thorough understanding of the US Family Health Plan, Health Insurance Exchange and Medicare benefit structure, program Manuals, and Policies and Procedures of the Health Plan. Must display good communication and conflict resolution skills, display an abiding empathy for members. Must be able to maintain a customer first attitude, resolving member issues within the structure and framework for program administration and in compliance with regulatory considerations. Must also be able to develop and manage the department within budgetary guidelines.
- Plan, implement and manage the Provider and Member Advocacy and Customer Service Programs.
- Supervise and manage the selection, training, development, appraisal, and work assignments of personnel.
- Monitor and analyze call flow and forecast requirements to support daily call activity Manage and develop strategic partnerships with third party suppliers and other internal stakeholders Conduct monthly staff meetings
- Ensure operational procedures and practices are well defined, documented and consistently applied
- Develop monitoring systems, tools and processes to evaluate and improve the quality of services delivered within the Member Services department.
- Submit daily, weekly, monthly, quarterly and annual reports as requested and as per contract specifications
- Set standards for and complete evaluations of direct reports
- Participates in member education and public relations/marketing efforts of CHP
- Instill a high-performance culture in the team with a focus on team work, service excellence and ownership for resolving customer issues
- Be capable of identifying and implementing change within the team to ensure it can take on new service offerings
- Set and cascade business objectives and targets to the team
- Participate in policy development and strategic planning Establishes and coordinates with Manager of Grievance and Appeals for the management of the grievance resolution process to monitor, track, report, and improve patient satisfaction
- Train and oversee development of Provider and Member Advocacy and Customer Service staff
- Maintain governing Member Handbooks, track changes, and notify and educate CHP staff about the plan benefit changes.
- Participates in plan wide activities and collaborates with other departments as needed to ensure optimum delivery of care and services to members
- Ensures department's compliance with DoD, CMS, HHSC and other applicable regulatory, NCQA and URAC standards and represents CHRISTUS during audits.
- Collaborate with all other departments as appropriate and required to facilitate the completion of tasks/goals
- Follows the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability ACT (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)
- College degree preferred or 10-15 years work related experience
- Knowledge of healthcare management and managed care operations
- Proficient in use of word processing, spreadsheet applications
- Working knowledge of statistical processes and methods
- Minimum 10 years health plan call center experience
- Minimum 7 years management experience