Member Services Manager
Location: Orange, California US
Job Number: 1372
Position Title: Member Services Manager
The Member Services Manager is responsible for the day to day operations of the Member Services Department. Collects data on member inquiries to identify trends and recommend solutions. Ensures representatives follows established policies for addressing member inquiries and meet quality service goals. Manages the recruitment, hiring, training, scheduling, and performance management of staff.
Essential Duties and Responsibilities
Essential duties and responsibilities include but are not limited to:
- Defines, and monitors performance and productivity standards specific to those systems that must be in place to serve the health plan’s enrolled population.
- Ensures that employed staffs possess the skills and training necessary to communicate effectively with the plan’s membership.
- Manages the recruitment, hiring, training, of new staff members.
- Responsible for employee evaluations and on-going customer service training programs.
- Responsible for ensuring that call center staff answer the incoming phone queue calls according to CMS defined standards, and inquiries addressed according to department protocols.
- Responsible for the review of Key Performance Indicator reports, analyze data to identify trends and recommend solutions.
- Assumes and maintains responsibility and accountability for the training, and overall performance of the Member Services staff to ensure that all qualitative and quantitative goals and objectives are met within the department.
- Maintain a working knowledge of significant developments (CRM) in the business.
- Assist with review of and creating of new department policies and procedures as needed to ensure the department is in accordance with CMS guidelines.
- Develop and encourage a spirit of cooperation, teamwork and accountability among all department employees.
- Provide direct reports clear, concise and appropriate communications and directions.
- Ensure direct reports are compliant with all department/company policies and procedures.
- Guide, mentor and coach direct reports for professional behaviors and to deepen their technical skill set (i.e., CRM, Encore, Enghouse, etc.,).
- Performs other duties as assigned.
Oversees the Member Services Department. Carries out managerial responsibilities in accordance with organization policies and applicable laws. Responsibilities include training of employees; planning, assigning and directing work; assisting in the rewarding and disciplining of assigned employees; addressing complaints and resolving problems as they pertain to the department.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Education and/or Experience: High school diploma or general education degree (GED); and three to five years related experience and/or training; or equivalent combination of education and experience.
- Certificates, Licenses, Registrations: None required.
- Other Qualifications:
- Bachelor's degree (BA or BS) preferred.
- Knowledge of Medicare Managed Care Plans required.
- Three to five years customer service call center experience required.
- Previous Supervisory experience or equivalent.
- Bi-lingual (English/Spanish) required.
Skills and Abilities
- Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.
- Mathematical Skills: Ability to add and subtract two digit numbers and to multiply and divide with 10’s and 100’s. Ability to perform these operations using units of American money and weight measurement, volume, and distance.
- Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.
- Computer Skills: Strong computer skills.
- Other Skills and Abilities:
- Excellent communication skills.
- Excellent telephone techniques.
- Excellent data entry.
- Strong organizational skills.
- Type 40+ words per minute.
- Experience with 10-key by touch.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
- The employee is frequently required to walk; stand; reach with hands and arms.
- The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl.
- The employee must occasionally lift and/or move up to 20 pounds.
- Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually moderate
Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.
Location City: Orange
Location State: California
Community / Marketing Title: Member Services Manager
Who is Alignment Healthcare?
- Socially responsible
- Technologically enabled
- Concierge care
- Servant leadership
We are dedicated to transforming the complex and confusing process of medical treatment in the United States so that every link in the health care continuum becomes more efficient, productive, and effective. We built a team of people who want to make a difference. Come join the team that is changing health care one person at a time.
We believe that great work comes from people who are inspired to be their best. We invite you to explore our wide variety of roles based on your unique experience.
EEO Employer Verbiage:
If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact firstname.lastname@example.org.