Member Services Manager

Willamette Dental•Hillsboro, OR

3d•$87,500 - $106,000

About The Position

The Member Services Manager manages the daily operations of a team of representative that provides support and services to members and other associated individuals and groups. In addition, this position manages an escalation team that investigates and processes grievances and appeals to resolutions and benefits, oversees duties involving contractual obligations to heightened/complex Care Coordination cases, and contractual processes involving consequences resulting from member/patient behavioral issues.

Requirements

Bachelor’s degree and 5 years progressive professional experience performing work related to customer service, preferably in healthcare and at least 2 years' experience managing a diverse team OR an equivalent combination of education and/or experience which will provide the ability to perform the essential functions of the position.

Nice To Haves

A demonstrated background in significant leadership roles with a history of setting and achieving “stretch” goals is preferred.

Responsibilities

Provides leadership and direction to the Member Services Representatives, Grievance & Appeal Coordinators and Assurance Coordinator.
Leads continued development and implementation of the Member Services Department training program, including continual updates of the essential procedures, day to day operation, staff productivity and engagement.
Provides guidance to staff in the review, research and monitoring of complaints, grievances and appeal cases. Assuring timely, comprehensive and appropriate documented resolution is achieved.
Completes periodic audits to ensure timely, professional and customer-focused responses to complaints, processing of adverse benefit determinations, grievance and appeals, while maintaining compliance with certificates of coverage and OARS.
Instills quality communications by developing expectations, standard operating procedures and performing periodic audits.
Maintains thorough and accurate documentation of departmental audits.
Regular monitoring to ensure tracking and reporting is performed per Insurance/Provider agreements, Service Level Agreements are met, OARS are followed in our scope of work and adheres to other regulatory requirements .
Ensures thorough and timely preparation of reports and submissions for all plans.
Addresses both internal/external customer needs and concern related activities. Ensures programs support toward overall quality improvement, assurance to meet regulatory compliance and adherence to the company standards.
Working across all departments and the dental practice to achieve full grievance and appeal resolutions.
Manages challenging and or complex grievances and appeals that require escalation and continued evaluation.
Establishes and maintains effective communication with reports through regular staff meetings to share information.
Responsible for the hiring, coaching, mentoring and performance evaluation of the Member Services team.

Benefits

medical, dental and vision insurance
tuition reimbursement
flexible spending accounts
401(k) retirement plan with 5% match
accidental death and dismemberment insurance
life insurance
voluntary disability insurance
commuter benefits
two complimentary pairs of Fig scrubs (clinical roles)
employee assistance program
Eligible employees will accrue a minimum of 120 PTO hours per employment year in addition to seven paid holidays annually.
The Company’s PTO program combines vacation and sick leave, which is more generous than Washington State’s Sick Leave Law.
Employees in part-time roles working less than 40 hours per week will accrue PTO on a pro-rated basis.