Member and Provider Services Manager

Group Health Cooperative•Altoona, WI

1d•Onsite

About The Position

The Member and Provider Services Manager is responsible for the overall management of the Service Department, including policies, procedures, operating structure, and establishing department standards and guidelines. This role ensures timely and professional handling of member and provider inquiries, accurate responses, and achievement of department performance goals through monitoring, reporting, coaching, and identifying process improvements. The manager will address and resolve complex member and provider issues, system programming, and contract/policy matters, while also facilitating departmental meetings and representing the department in various meetings. Additionally, this role involves creating, interpreting, and reviewing departmental policies and procedures, managing staff schedules, establishing performance standards, ensuring compliance, and fostering a positive and supportive work environment to maintain high employee morale and minimize turnover.

Requirements

Prior supervisory or management experience.
Minimum of three years’ prior customer service experience.
Proficiency in Microsoft Word and Excel.
Excellent communication and organizational skills.

Nice To Haves

Prior claims management experience preferred.

Responsibilities

Ensure that member and provider phone calls are answered in a timely and professional manner by the service department team.
Ensure that member and providers receive accurate response to their inquiries.
Ensure department performance goals are met through the continual monitoring, reporting, observing, and coaching.
Identify process improvement initiatives and implement such initiatives.
Address and resolve complex non-routine member and provider issues.
Address system programming, contract/policy issues and assure a timely resolution.
Assign projects and share information with the appropriate parties.
Address and resolve complex departmental issues from other departments, external vendors, and members.
Resolve contract language confusion.
Address system programming and procedural issues and ensure a timely resolution.
Ensure department adherence to NCQA accreditation standards.
Facilitate departmental meetings to communicate relevant information.
Represent the Member and Provider Services department in internal and external meetings.
Create, interpret, and review of departmental policies and procedures.
Schedule staff, vacation, etc., to meet the staffing needs of the department.
Establish and review performance standards for departmental personnel.
Ensure departmental compliance with company policies, procedures, standards and regulations.
Maintain high employee morale, promote staff enthusiasm and teamwork, minimize turnover, assist employees with concerns and support staff in their job functions.
Approve employees’ time for payroll.