Member Services Senior Manager

POSITION SUMMARY/RESPONSIBILITIES
Directs, supervises, and assists with the activities of the Member Services Commercial (EPO / PPO), Health Exchange and CHIP hot-lines. Works with departmental leadership to improve any barriers that result in lines of business member’s complaint processes, working closely with member service resolution team and member advocates that result in trends and/or other tasks that the unit is responsible for. Leads, manages and is responsible and knowledgeable for ensuring all aspects of all compliance/regulatory/contractual including internal/external audits, and accredited agencies are abided. To include identifying potential high-risk situations, providing documentation, timely response, and coordination with Community First departments, including leading and organizing as-needed meetings required to ensure that task is met. for. Ensures that all forms of member inquiries, correspondence, complaints, Initial Concern Complaints, and appeals are acknowledged, investigated, resolved, and responded in accordance with Community First Health Plans (Community First) policies, as well as abide by any accredited organizations, federal and state regulatory entities. Ensuring that staff within this unit are current by communicating any changes that occur. Supporting the other units within Member Services as needed and/or as directed by the Directors of Member Services. Responsible and accountable for ensuring that staff are knowledgeable in conjunction with collaborating and updating the department trainer to identify gaps, refresher training and/or communicating any changes related to these lines of business to including monitoring call center quality outcomes/needs, to ensure all regulatory and/or contractual requirements are met. In addition to conducting analysis/deliverable reports upon request. Consistently supports compliance by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to the applicable federal, state, and local laws and regulations, accreditation and licenser requirements (if applicable), and CFHP policies and procedures. In addition, must be accountable for the communication, implementation, enforcement, monitoring and oversight of compliance policies and practices, including the Health Insurance Portability and Accountability Act (HIPAA) related policies in regard to aspects of operations within Member Services.

EDUCATION/EXPERIENCE
Bachelor’s degree OR a minimum of four years of supervisory work in healthcare administration, managed care; general healthcare industry which consists of strong customer service call center, enrollment, and outreach experience, is required. At least 2 years' experience developing staff, multiple mainframe systems, ACD Phone Software, and using MS software are required (heavy experience with Excel or access is strongly preferred). The ability to speak, read, and write in both English and Spanish is strongly preferred. Preferred strong experience in call center supervision, training, and being able to develop “Best Practices” talent.

LICENSURE
A valid Texas driver’s license is required and may need to travel to Community First other office locations to assist as needed.