Healthcare Member Services Manager
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Job Description
Member Services Lead overseeing a TPA program for federal health services; managing member request processing and call center operations.
Responsibilities:
- Lead a team of over 30 FTEs responsible for application and member request processing,
- Call center services, and operational and data quality support
- Serve as the main point of contact for our customer, working closely to resolve complex and sensitive applicant and member issues
- Own workflow prioritization and service levels across all member touchpoints providing operational support,
- Guidance, and subject-matter expertise for the member services team
- Drive workforce management practices (forecasting,
- Scheduling,
- Adherence), while managing onboarding,
- Training programs, and ongoing coaching programs,
- And performance reviews in collaboration with supervisory staff.
- Foster a member-first culture of accountability, service excellence, and continuous improvement.
- Manage performance against KPIs and AQL metrics (processing times,
- Turnaround,
- Quality,
- Follow up activities,
- Data accuracy,
- Backlog/aging).
- Conduct root-cause analysis on performance issues; implement data-driven corrective actions and continuous improvement initiatives
- Partner with QA and Training to refine call handling,
- Knowledge base content, and process SOPs.
- Collaborate with cross-functional teams to resolve member-impacting issues and streamline service processes
- Track trends in member concerns, case types, and operational challenges; communicate insights to leadership
- Partner with the business analyst team to continuously identify process improvements that enhance member experience,
- Quality, and workflow efficiency and utilize data to improve operations,
- Exchanges with trading partners, and identify new trends across the program
- Ensure compliance with HIPAA and federal program requirements; maintain robust PHI safeguards and audit-ready documentation.
Requirements:
- 7+ years of progressive experience in health plan or TPA operations, specific to member services, customer service, and call center operations
- 5+ years of people leadership, managing teams in a high-volume service environment
- Demonstrated track record of root-cause analysis, issue triage, and rapid corrective action
- Strong command of call center operations, process optimization, and KPI/SLA management
- Demonstrated ability to utilize automated tools to enhance daily operational processes
- Proficiency with operational dashboards,
- Ability to partner on SQL/Excel analyses and translate insights into action
- Excellent communication and stakeholder management skills; able to brief government customer and collaborate with counterparts
- HIPAA knowledge and commitment to protecting PHI.
Benefits:
- Our benefits package for all US-based employees includes a variety of medical plan options
- Some with Health Savings Accounts
- Dental plan options
- A vision plan
- A 401(k) plan offering the ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match
- To encourage work/life balance, GDIT offers employees full flex work weeks where possible and a variety of paid time off plans
- Including vacation
- Sick and personal time
- Holidays
- Paid parental
- Military
- Bereavement and jury duty leave
- GDIT typically provides new employees with 15 days of paid leave per calendar year to be used for vacations, personal business, and illness and an additional 10 paid holidays per year
- Paid leave and paid holidays are prorated based on the employee’s date of hire
- The GDIT Paid Family Leave program provides a total of up to 160 hours of paid leave in a rolling 12 month period for eligible employees
- To ensure our employees are able to protect their income, other offerings such as short and long-term disability benefits,
- Life
- Accidental death and dismemberment
- Personal accident
- Critical illness and business travel and accident insurance are provided or available.
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