We are seeking a dedicated and customer-focused Member Services Manager. This role is responsible for overseeing the daily operations of the Tier 1 and Tier 2 member services team, ensuring high-quality service and resolving complex member inquiries. The ideal candidate will be an experienced leader with strong problem-solving skills and a commitment to enhancing the member experience through efficient processes and effective team management.
Responsibilities:
- Manage and support T1 and T2 Member Services team in handling escalated member inquiries and complex issue resolution.
- Monitor performance metrics; ensuring individual performance is maintained in line with business key performance indicators.
- Train, coach and develop team members to enhance service quality and operational efficiency.
- Collaborate with cross-functional teams to improve member support processes and address systemic issues.
- Strategically plan and forecast needs for upcoming launches or new product offerings.
- Ability to proactively scale to business demands through resource planning, process and application reviews.
- Proactively manage volume and flex resources as needed to ensure proper resource and SLA cover.
- Ensure compliance with healthcare regulations, policies and organizational standards.
- Analyze trends in member inquiries and develop strategies to proactively address common concerns, raise awareness and implement change.
- Provide reports and insights on team performance, business performance, member satisfaction and operational challenges to leadership.
- Suggest and support process improvements to streamline operations and enhance the overall member experience.
- Serve as a point of escalation for highly complex cases requiring in-depth problem resolution.
- Foster a positive and supportive team environment; promoting professional growth and engagement and leveling up team capabilities and learning regularly.
- Strong working knowledge of Enrollment, T1 and T2 Inbound and Outbound Customer Service, Sales and Technical support (ie ticketing methodology, dialer optimization, high quality csat).
Qualifications:
- Bachelor’s degree in Healthcare Administration, Business, Communications or a related field (Master’s degree preferred).
- 5+ years of experience in customer service or member services within the healthcare industry.
- 2+ years of leadership or managerial experience in a service center or call center environment.
- Strong understanding of healthcare benefits, insurance policies and regulatory compliance.
- Excellent problem-solving and conflict resolution skills.
- Strong communication and leadership skills to manage teams and projects effectively.
- Proficiency in data analysis and reporting tools to monitor team performance.
- Ability to work collaboratively in a fast-paced, member-focused environment.
- Experience with CRM and ticketing systems is a plus.
- Bilingual in Spanish preferred.
$65,000 – $70,000 a year
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