Job description

Why This Role is Important to Us:

Under the supervision of the Member Services Manager, Supervisor, Member Services provides leadership for and direct supervision of Member Services Representatives to ensure that accurate, prompt, and courteous service is provided in response to written and telephonic inquiries, from members, members’ caregivers, Primary or Interdisciplinary Care Team Members, pharmacies, and vendors. The Member Services Supervisor provides oversight to the Member Services center and is responsible for ensuring staff provides quality member care and service delivery by responding to enquiries immediately and directly, when possible, or by collaborating with our Interdisciplinary or Primary Care Teams, Clinical Staff, and others involved in providing care for our members. The Member Services establishes and maintains successful interrelationships with internal and external collaborators to best meet the needs of the members, department, and organization.

What You'll Be Doing:

• Creates and maintains a high quality and productive team environment to keep Member Services team motivated to perform at their highest level.
• Manages daily staff assignments ensuring inquiries and requests are responded to and documented according to protocols.
• Serves as the initial and primary contact for the third-party administrators.
• Collaborates with the Member Services leadership team to assure that the interface between Transportation Unit and Member Services is effective.
• Communicates with appropriate clinical team staff and Clinical Decision Support Team leadership to make sure authorizations are processed per protocols.
• In collaboration with the Appeals/Grievance Coordinator and the designated Transportation Services staff, assists in the review of transportation-related complaints.
• Represents Member Services at internal and external meetings.
• Evaluates staff performance and administers introductory and annual performance evaluation meetings as well as meetings to address performance and corrective action issues as appropriate.
• Demonstrates exemplary leadership, exceptional work ethic, ability to prioritize task; able to work under pressure and strive to find creative solution.
• Assists staff with resolving problems, developing independence and use of resources, and using solid judgment skills.
• Fulfills the duties of the Member Services Representative when required and/or as scheduled; refer to the Member Services Representative for specific responsibilities
• Adhere to all applicable compliance requirements and the Code of Conduct.
• Secondary Responsibilities - Day-to-day activities within guidelines - Influence operational priorities - Low to medium degree of authority - Execution of day-to-day activities - Solid functional expertise - Emerging management skills

What We're Looking For:

Bachelor's Degree or equivalent experience
3-5 years of experience - Solid functional expertise - Emerging management skills - English, bilingual preferred

Job Type: Full-time

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