Member and Provider Service Supervisor

WellSense Health Plan

3d•$57,500 - $83,500•Remote

About The Position

The Member and Provider Service Supervisor ensures outstanding customer service by resolving issues and providing accurate information to WellSense members and providers. The role participates in recommending, developing, and implementing short- and long-term service quality strategies that improve satisfaction and operations, and serves as a subject matter expert and resource as needed. The supervisor directly oversees Member and Provider Service Center staff and ensures they have the tools and resources needed to meet or exceed state contractual requirements and corporate standards across product lines. The role proactively identifies and resolves service barriers—including claims, eligibility, enrollment, prior authorization, and benefits—in collaboration with partner departments. Working closely with the Member and Provider Service management team, the supervisor supports high service standards, regulatory compliance, and continuous improvement. This is a full-time remote role. The operation runs from 8 a.m. to 8 p.m., seven days a week at certain times of the year, and the supervisor must be flexible with shifts and hours. The position supervises 5–15 staff.

Requirements

Three or more years of call center experience preferred.
Three or more years of experience in healthcare or managed care preferred.
Three or more years of supervisory experience preferred.
Demonstrated critical-thinking and analytical skills.
Strong problem-solving skills and ability to understand cause and effect.
Strong oral and written communication skills and ability to interact at all organizational levels.
Effective collaboration and proven process-improvement skills.
Strong working knowledge of Microsoft Office products.
Demonstrated ability to plan, organize, and manage projects successfully.
Detail-oriented, with strong proofreading and editing skills.
Ability to be flexible with shifts and hours for an operation that runs 8 a.m. to 8 p.m., seven days a week at certain times of the year.

Nice To Haves

Bachelor’s degree, or an equivalent combination of education, training, and experience, preferred.
Three or more years of call center experience preferred.
Three or more years of experience in healthcare or managed care preferred.
Three or more years of supervisory experience preferred.

Responsibilities

Implement department policies, procedures, and standards, and supervise telephonic and office operations to meet productivity targets, quality standards, and operational goals.
Participate in developing policies and procedures to support outstanding service delivery and member and provider satisfaction.
Analyze call volumes daily and adjust staff scheduling and resources to meet inbound provider demand, performance goals, and efficiency needs.
Ensure monthly compliance with corporate standards.
Establish, maintain, and refine intra- and interdepartmental processes and procedures across product lines.
Monitor staff compliance with established workflows.
Resolve first-line policy questions referred by staff and collaborate with partner supervisors and managers on resolutions.
Ensure staff have the technology and training needed to provide outstanding customer service.
Collaborate with the Trainer to identify training opportunities and effective delivery methods using metrics and staff feedback; train or oversee staff training.
Coordinate with the management team on work allocation and share resources as needed to meet state requirements.
Conduct one-on-one quality feedback sessions to coach and develop direct reports.
Take client or customer calls and provide coverage for assistants as needed.
Monitor call trends to identify current and potential member and provider service issues.
Assist with budget planning as needed.
Contribute to the development and maintenance of member and provider materials.
Maintain current knowledge of WellSense and payment and reimbursement policies, member coverage and benefits, and claims adjudication rules.
Maintain knowledge of WellSense benefits, provider network development and contract issues, Massachusetts Medicaid regulations, payment and reimbursement policies, and claims processing industry standards.
Maintain knowledge of the FACETS Customer Service Module, AVAYA, CCMS, and other systems used by Member and Provider Services staff and management.
Lead project activities, including assigning tasks, setting schedules, and resolving project issues.
Represent the department on cross-functional initiatives.
Perform other tasks as needed to support Member and Provider Services and WellSense goals.