Supervisor Member Services - Health Plan Admin

Summary:

The Supervisor Member Services should possess strong supervisory/leadership skills including planning, organizing, directing, and coordinating the activities of Provider and Member Advocacy and Customer Service. Requirements include a thorough understanding of the US Family Health Plan, Medicaid, Health Insurance Exchange and Medicare benefit structure, program Manuals, and Policies and Procedures of the Health Plan. Must display good communication and conflict resolution skills, display an abiding empathy for members. Must be able to maintain a customer first attitude, resolving member issues within the structure and framework for program administration and in compliance with regulatory considerations.

Responsibilities:

• Oversees the day-to-day operations of the Member Services unit
• Includes scheduling to training
• Oversees the necessary auditing, loading and revising of benefit plans and claims as needed
• Facilitates member understanding of plan coverage and benefits by thoroughly researching inquiries and responding in a timely and professional manner
• Solves member problems on a case-by-case basis, recording into system for training purposes
• Must have excellent knowledge of the MIS system/s
• Supervises the overall training needs of the unit
• Works with other internal / external departments for better communication and teamwork
• Handles and coordinates special projects as needed
• Provides necessary back up to other departments when possible or needed on an interim basis
• Communicates with other internal / external departments and customers in order to promote new programs or changes

Requirements:

• High School Diploma

Work Type:

Full Time