Manager Member & Provider Operations

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond.  As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community.  Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day.  Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.
 

Position Summary
 

The Manager, Member Services is responsible for ensuring outstanding relationship development and management of customers to deliver a superior customer experience for members of all Martin’s Point Health Plan products. Partnering with leadership across the Health Plan, the manager helps to ensure a positive and seamless relationship continuum, from potential member education, through on-boarding and ongoing member service - with primary responsibility for delivering on service performance goals and member satisfaction with customer service. This role is responsible for the work processes that deliver service results and oversees all staff and processes supporting the service for Health Plan membership by establishing standards of service excellence performance, workforce planning, departmental policies and procedures, auditing, trending and other performance measurement techniques.

Job Description

Key Outcomes:

• Develops and manages the customer service and experience continuum (from post-sale through long-term service) to deliver the highest satisfaction and enduring relationships with our Health Plan members.
• Works across the health plan to drive service improvements based on member feedback.
• Develops and maintains a team approach in the management of employees.
• Guides the development of reports to identify trends, increase functionality, and evaluate employee performance. Drives improvements based on data.

• Collects and analyzes member and market information to aid in the development of initiatives and activities for engaging members and inform product development.
• Analyzes and trends phone queues to guide workforce planning and maximize use of telephone system.
• Analyzes and trends in member service data which results in the identification of process improvement activities improving member and employee experience and satisfaction (e.g. call tracking reports, telephone reports, satisfaction surveys, etc.).
• Designs and implements operational processes and systems that increase customer service levels.

• Acts as advisor to Health Plan leadership regarding member inquiry trends.
• Works collaboratively with other departments and with organizational functions to maximize operational efficiency, quality and effectiveness of service.
• Manages and coaches member services staff to perform effectively, as a team, to support MP strategies with an intense focus on customer service/support and proactive problem solving.
• Manages operational auditing activities set forth by CMS and DOD for the functions denoted above.

Education/Experience:

• Bachelor degree or equivalent combination of relevant education and experience required
• 5 years related experience in business, insurance, health care and/or customer service required
• Experience in a Managed Care customer service environment preferred
• Leadership experience (staff and/or projects) required. Prior experience in service, supervision of staff, training, operations preferred

Skills/Knowledge/Competencies (Behaviors):

• Ability to build and manage strong internal and external relationships
• Proficient in using data analysis software
• Strong customer service orientation
• Excellent organizational skills

• Exceptional public speaking skills
• Ability to multitask
• Detail oriented with continuous attention to compliance/contractual requirements

There are additional competencies linked to individual contributor, provider and leadership roles. Please consult with your leader to discuss additional competencies that are relevant to your position.

This position is not eligible for immigration sponsorship.

We are an equal opportunity/affirmative action employer.

Do you have a question about careers at Martin’s Point Health Care? Contact us at:[email protected]