The Member Services Manager should possess strong supervisory/leadership skills including planning, organizing, directing, and coordinating the activities of Patient Advocacy and Customer Service. Requirements include a thorough understanding of the US Family Health Plan benefit structure, TRICARE 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. Must also be able to develop and manage the department within budgetary guidelines.
Plan, implement and manage the Provider and Member Advocacy and Customer Service Programs.
Supervise and manage the selection, training, development, appraisal, and work assignments of personnel.
Monitor and analyze call flow and forecast requirements to support daily call activity Manage and develop strategic partnerships with third party suppliers and other internal stakeholders Conduct monthly staff meetings
Ensure operational procedures and practices are well defined, documented and consistently applied
Develop monitoring systems, tools and processes to evaluate and improve the quality of services delivered within the Member Services department.
Submit daily, weekly, monthly, quarterly and annual reports as requested and as per contract specifications
Set standards for and complete evaluations of direct reports
Participates in member education and public relations/marketing efforts of CHP
Instill a high performance culture in the team with a focus on team work, service excellence and ownership for resolving customer issues
Be capable of identifying and implementing change within the team to ensure it can take on new service offerings
Set and cascade business objectives and targets to the team
Participate in policy development and strategic planning Establishes and coordinates with Manager of Grievance and Appeals for the management of the grievance resolution process to monitor, track, report, and improve patient satisfaction
Train and oversee development of Provider and Member Advocacy and Customer Service staff
Maintain governing Member Handbooks, track changes, and notify and educate CHP staff about the plan benefit changes.
Participates in plan wide activities and collaborates with other departments as needed to ensure optimum delivery of care and services to members
Ensures department's compliance with DoD, CMS, HHSC and other applicable regulatory, NCQA and URAC standards
Collaborate with all other departments as appropriate and required to facilitate the completion of tasks/goals
Follows the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability ACT (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)
A. Education/ Skills
College degree preferred or 10-15 years work related experience
Knowledge of healthcare management and managed care operations
Proficient in use of word processing, spreadsheet applications
Working knowledge of statistical processes and methods
Minimum 10 years health plan call center experience
Our Mission: WHY WE EXIST. To extend the healing ministry of Jesus Christ. Our Core Values: WHAT WE BELIEVE IN.DIGNITY Respect for the worth of every person, recognition and commitment to the value of diverse individuals and perspectives, and special concern for the poor and underserved. INTEGRITY Honesty, justice, and consistency in all relationships. EXCELLENCE High standards of service and performance. COMPASSION Service in a spirit of empathy, love, and concern. STEWARDSHIP Wise and just use of talents and resources in a collaborative manner.Our Vision: WHAT WE ARE STRIVING TO DO. CHRISTUS HEALTH, a Catholic health ministry, will be a leader, a partner and an advocate in the creation of innovative health and wellness solutions that improve the lives of individuals and communities so that all may experience God's healing presence and love. Our Name and Symbol:WHO WE ARE. CHRISTUS is Latin for "Christ," and proclaims publicly the core of our mission. OUR NAME choice also recognizes the heritage of our two congregational sponsors, the Sisters of Charity of the Incarnate Word in Houston and San Antonio. Jesus Christ is the Incarnate Word, the Word of God made flesh. It is, theref...ore, only fitting that it is in another form of His name that our health ministries are called together. OUR SYMBOL Reflects the healing ministry of Jesus Christ - a combination of a medical cross and a religious cross. The flowing banner on the cross is a common symbol of the risen Christ, while the royal purple signifies Christ. The flowing banner also conveys a sense of motion as we move forward into a new era of service to our communities.