What are the responsibilities and job description for the Member and Provider Services Manager position at Group Health Cooperative of Eau Claire?
Position Purpose
The purpose of the Member and Provider Services Manager is to provide overall management of the Service Department. Manage policies, procedures and operating structure and establish department standards and guidelines.
Essential Position Functions
The purpose of the Member and Provider Services Manager is to provide overall management of the Service Department. Manage policies, procedures and operating structure and establish department standards and guidelines.
Essential Position Functions
- Ensure that member and provider phone calls are answered in a timely and professional manner by the service department team.
- Ensure that member and providers receive accurate response to their inquiries.
- Ensure department performance goals are met through the continual monitoring, reporting, observing, and coaching.
- Identify process improvement initiatives and implement such initiatives.
- Address and resolve complex non-routine member and provider issues.
- Address system programming, contract/policy issues and assure a timely resolution.
- Assign projects and share information with the appropriate parties.
- Address and resolve complex departmental issues from other departments, external vendors, and members.
- Resolve contract language confusion.
- Address system programming and procedural issues and ensure a timely resolution.
- Ensure department adherence to NCQA accreditation standards.
- Facilitate departmental meetings to communicate relevant information.
- Represent the Member and Provider Services department in internal and external meetings.
- Create, interpret, and review of departmental policies and procedures.
- Schedule staff, vacation, etc., to meet the staffing needs of the department.
- Establish and review performance standards for departmental personnel.
- Ensure departmental compliance with company policies, procedures, standards and regulations.
- Maintain high employee morale, promote staff enthusiasm and teamwork, minimize turnover, assist employees with concerns and support staff in their job functions.
- Approve employees’ time for payroll.
Minimum Requirements of the Position
- Prior supervisory or management experience.
- Prior claims management experience preferred.
- Minimum of three years’ prior customer service experience.
- Proficiency in Microsoft Word and Excel.
- Excellent communication and organizational skills.
Group Health Cooperative of Eau Claire complies with applicable Federal civil rights laws and does not discriminate, exclude or treat candidates less favorably on the basis of race, color, national origin (including limited English proficiency and primary language), age, disability, or sex (including sex characteristics, including intersex traits; pregnancy or related conditions; sexual orientation; gender
identity; and sex stereotypes).
The Cooperative is committed to fostering a caring and compassionate environment while ensuring that individual differences are valued. The Cooperative is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. It is essential that all employees and members feel secure and welcome, that the opinions and contributions of all individuals are respected and that all voices are heard.
This full time position offers an outstanding benefit package, including three weeks of vacation the first year, a generous retirement plan, health and dental insurance, a wellness program, and much more! If you are interested in working for an organization focused on a team atmosphere and is dedicated to providing exceptional service submit your resume today! Send resume to: resumes@group-health.com. Group Health Cooperative of Eau Claire is an affirmative action and equal opportunity employer.
identity; and sex stereotypes).
The Cooperative is committed to fostering a caring and compassionate environment while ensuring that individual differences are valued. The Cooperative is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. It is essential that all employees and members feel secure and welcome, that the opinions and contributions of all individuals are respected and that all voices are heard.
This full time position offers an outstanding benefit package, including three weeks of vacation the first year, a generous retirement plan, health and dental insurance, a wellness program, and much more! If you are interested in working for an organization focused on a team atmosphere and is dedicated to providing exceptional service submit your resume today! Send resume to: resumes@group-health.com. Group Health Cooperative of Eau Claire is an affirmative action and equal opportunity employer.
