Member Services Manager

Medical Associates • Dubuque, IA

8h • Onsite

About The Position

Medical Associates Health Plans is hiring a Manager of Member Services to oversee member support, eligibility and enrollment, assigned appeals and grievance functions, and resolution of escalated issues. The role provides leadership in staff development, workforce planning, service quality, process improvement, and adoption of approved technology to improve the member experience and operational effectiveness. This is an onsite position at Medical Associates Health Plans in Dubuque, Iowa.

The manager leads service operations across phone, written, digital, and in-person channels, including reception coverage; plans staffing around demand and workload; and monitors service levels, response times, call abandonment, and backlogs. The manager also leads hiring, onboarding, scheduling, coaching, performance evaluations, employee development, cross-training, backup coverage, and succession planning.

The position oversees eligibility and enrollment workflows, member data accuracy, file reconciliation and corrections, and appropriate controls and documentation. It also oversees quality reviews, departmental policies and procedures, assigned appeals and grievances, compliance-related deadlines and reporting, and escalated issues through resolution.

The manager identifies operational risks and improvements, implements approved changes, maintains SOPs and training resources, and leads adoption of approved technology, automation, and AI-assisted tools. The position coordinates member communications and materials, represents Member Services in product, system, and group implementations, and works with internal departments, vendors, and content owners to coordinate workflows, reviews, distribution, and staff readiness. Additional projects and responsibilities may be assigned.

Requirements

• At least three years of relevant experience in member or customer service, health insurance, healthcare administration, or comparable service operations.
• Demonstrated team leadership, coaching, or staff development experience.
• High school diploma or equivalent required.
• Ability to interpret service and workload data, plan coverage, prioritize competing demands, document procedures, manage escalations, and coordinate work across departments.
• Ability to implement changes, identify risks, develop practical solutions, and evaluate service quality and operational results.
• Proficiency with business applications, operational systems, and reports, and ability to learn new technology and train staff.
• Ability to assess output against approved information and follow established privacy, security, and escalation practices.
• Strong written and verbal communication, sound judgment, discretion, and diplomacy.
• Ability to explain complex information clearly, handle sensitive concerns with empathy, coach employees, address difficult issues, and build cooperative relationships with members, colleagues, employers, brokers, and vendors.
• Ability to maintain confidentiality and work effectively across departments.

Nice To Haves

• Formal supervisory experience.
• Experience with health plan or TPA operations, Medicare and commercial products, eligibility and enrollment, appeals and grievances, or contact-center management.
• An associate or bachelor's degree in business, healthcare administration, management, or a related field.
• Experience implementing knowledge-management tools, automation, or AI-assisted workflows.

Responsibilities

• Manage daily phone, written, digital, and in-person service workflows, including reception coverage.
• Plan staffing based on service demand, workload, enrollment activity, PTO, training, and overtime.
• Monitor service levels, response times, call abandonment, and backlogs; address gaps, report performance, and ensure accurate benefit and coverage information.
• Lead hiring, onboarding, scheduling, coaching, performance evaluations, and employee development.
• Establish service and performance expectations, address concerns with Human Resources, and assess staff proficiency.
• Develop cross-training, backup coverage, and succession plans; support team leaders and communicate changes effectively.
• Oversee eligibility and enrollment workflows to ensure accurate member data and timely processing.
• Coordinate file issues, reconciliation, and corrections with Configuration, IT, vendors, and other departments.
• Maintain appropriate controls and documentation and ensure staff follow procedures and escalate exceptions.
• Oversee quality reviews of calls, correspondence, transactions, and documentation; address errors and maintain current departmental policies and procedures.
• Coordinate assigned appeals and grievances, including deadlines, documentation, and reporting, with Compliance.
• Track escalated issues through resolution, coordinate corrections with responsible teams, and ensure compliance with applicable regulations and accreditation requirements.
• Identify operational risks and workflow improvements, implement approved changes, and evaluate results.
• Maintain current SOPs, training resources, and approved knowledge content; lead adoption of approved technology, automation, and AI-assisted tools.
• Partner with IT, Analytics, Compliance, and content owners on requirements, testing, and training while reinforcing accuracy, source verification, human review, and privacy.
• Coordinate accurate and timely member communications and materials for enrollment, renewals, terminations, ID cards, and digital information.
• Partner with content owners, Compliance, the Mailroom, and vendors to manage reviews, distribution, and delivery issues.
• Represent Member Services in product, system, and group implementations, coordinating staff readiness and workflows with Claims, Configuration, Sales, account management, and other departments.
• Complete additional projects and responsibilities as assigned.
• Proactively manage projects and long-term goals, establish timelines and action owners, and ensure commitments are met.
• Gather information, evaluate impacts and risks, make timely decisions, and manage resources responsibly.
• Model respectful and cooperative relationships, promote team understanding and collaboration, motivate employees, and address morale issues.
• Communicate openly and effectively, build commitment and loyalty, manage difficult issues with empathy and clarity, and promote a non-threatening environment for expressing opinions.
• Implement new ideas and technologies, support change, remove obstacles, and ensure resources are available.
• Set performance and behavioral standards, promote accountability and skill development, provide feedback and evaluations, and support employee development and succession planning.
• Remain current with skills and industry knowledge and seek feedback for continual personal development.
• Anticipate internal and external customer needs, respond proactively, ensure satisfaction, and deliver quality work.
• Comply with Medical Associates policies and behave ethically.

Benefits

• Single or Family Health Insurance with discounted premium rates for wellness program participation.
• 401k with immediate matching (50% on the dollar up to 7% of pay) plus additional annual Profit Sharing.
• Flexible Paid Time Off Program (29 days off/year).
• Medical and Dependent Care Flex Spending Accounts.
• Life insurance.
• Long Term Disability Coverage.
• Short Term Disability Coverage.
• Dental Insurance.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: High school or GED