Manager, Customer Service & Member Relations

Job Description

The Manager of Customer Service and Member Relations is responsible for overseeing the performance of the Customer Service group. This includes ensuring prompt, professional, and timely responses from the Customer Service Call Center team, the Member Relations team, and the Customer Service Quality and Training teams. The Manager will work closely with the Director of Customer Service to ensure that all performance targets are met or exceeded. The Manager will consistently monitor key goals, with a particular focus on member retention, call center wait times, abandonment rates, and call volume. Additionally, the Manager will ensure that appropriate staffing levels are maintained and effectively managed.

Responsibilities

• Manage, monitor, and ensure Customer Service and Member Relations Supervisors and direct reports meet, maintain and/or exceed departmental goals.
• Create measures and goals to ensure all established standards are satisfactorily met.
• Evaluate and assess staff on a monthly (performing 1:1’s) and annual basis, providing timely performance evaluations and implementing corrective action when necessary.
• Analyze, track, and trend departmental performance and continually work to find opportunities for process improvement resulting in increased member retention and member satisfaction.
• Monitor and ensure regulatory compliance with all Customer Service member contact materials and communications, including monitoring use of Cultural and Linguistic services.
• Work with Quality coach to ensure compliance and adherence of company and department policies and procedures.
• Utilize resources and tools to identify staff member performance strengths and weaknesses.
• Work with other departments to identify ways to improve processes between business units to contribute to member satisfaction, departmental efficiencies and overall company success.
• Assess and identify factors which could create company risk and report to leadership with suggestions and plans (if determined) for timely remediation.
• Maintain comprehensive knowledge of company and department policies and procedures, goals, and targets.
• Assist with the development of job aids and other training tools and materials to be used by staff members to improving overall quality of interactions with customers.
• Provide staff members and leadership team with assistance, guidance, support with day-to-day duties and responsibilities as they pertain to knowledge gap, customer care and member retention.
• Energize, inspire, and motivate staff members to excel in their day-to-day performance.
• Develop and mentor staff members and leadership teams.
• Routinely perform staff recognition
• Collaborate with cross-departmental Directors and Supervisors on the matter of solutions, opportunities, and successes.
• Liaise with other functional/departmental staff to facilitate service strategies and ensure customer relations and retention.
• Attend and present at internal/external customer meetings and internal meetings with other company functions necessary to perform duties and aid development.
• Develop and maintain internal/external business relationships
  
  

Qualifications

Required Education/Experience:

• High School graduate required.
• Minimum of three to five (3-5) years management experience in an in-bound and outbound call center environment, preferably with strong Member Retention experience. At least three to five (3-5) years’ experience in Member/Customer Services preferably in a Managed Care environment (i.e., IPA, MSO, HMO).
  
  

Preferred Education/Experience:

• Bachelors Degree from a four-year college
• 5+ years of Manager experience in the healthcare industry is strongly preferred.
• Knowledge and experience in medical claims processing, referrals and authorizations, CPT, HCPCs and ICD-10 codes preferred.
• Industry knowledge of Medi-Cal, Medicare, and Medicaid programs.
  
  

Req. Certification/Licensure: None.

"Location-Based Pay Adjustment"

About Us

With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.