SCOPE OF ROLE

The Manager, Member Services role is to oversee three teams:

• Membership & Enrollment Specialists (MES). The MES team is dedicated to supporting members with 2nd-tier enrolment, eligibility, and billing issues for the Individual and Family Plan (IFP), Bright Health Secure (BHS), and Group lines of business. This team performs duties including inbound/outbound calling, enrollment issue research and resolution, and close collaboration with the Enrollment technical team as well as the MAPS Specialists.
• Member and Provider Services (MAPS) Specialists. The MAPS Specialists is team dedicated to working with members to establish rapport/connection and build confidence in Bright Health. The MAPS Specialist team is responsible for identifying and rectifying any complicated member or provider issue Bright Health’s insurance benefits, claim processes, or enrollment and premium billing processes for all lines of business inclusive of Medicare Advantage.
• The Mail Operations. The Mail Operations team is responsible for handling inbound and returned mail including but not limited to member inquiries and payments, outbound materials, and returned provider checks.

The Manager will assist in establishing call center objectives, provide representatives with opportunities to expand their knowledge of services, products, and troubleshooting techniques, analyze call center data, and focus on improving performance and processes in an effort to better support customers. You should have exceptional communication, interpersonal, and customer service skills, as well as comprehensive knowledge of company policies and offerings.

ROLE RESPONSIBILITIES

The Member and Provider Services Manager will build and lead a multi-functional team of Service Specialists focused on providing concierge-level service for Bright members. The following description is intended to point out major responsibilities within the team’s role, but it is not limited to these functions:

• DAILY RESPONSIBILITIES
  • Directs and monitors the daily activities of the Membership & Enrollment Specialist Supervisors with respect to their oversight duties for the Membership & Enrollment Specialists which include, but are not limited to: assigning incoming Quarantine tickets, Incoming calls, Generating/Regenerating Invoices, Posting Premium payments including Suspense Account payment matching, MES Call Logs, Underwriting Inbox, Returned Mail
  • Monitors real-time call center performance to ensure that Membership and Enrollment Specialists are available to handle calls from members according to prescribed performance levels (MES)
  • Tracks Membership and Enrollment Specialist Supervisor and Specialist productivity and quality performance on a monthly, quarterly and annual basis to provide feedback as well as to ensure established key performance measures are achieved
  • Maintains and improves call center operations by monitoring system performance; identifying and resolving problems; preparing and completing action plans; completing system audits and analyses; managing system and process improvement and quality assurance programs; installing upgrades (SST)
  • Oversees mail room operations to ensure timely processing and adherence to regulatory requirements
• MONTHLY RESPONSIBILITIES
  • Collaborates on Bright Health Plan’s Policies and Procedures and Operational Guidelines including Desk Level Procedures
    Supports development and oversight of training to ensure Membership and Enrollment Supervisors and Specialists have the necessary expertise to carry out their jobs
  • Coordinates with Membership and Enrollment Managers to ensure that Billing Invoices, Grace Period Notices and Immediate
  • Grace Period Notices are generated in accordance with the monthly billing calendar
  • Prepares call center performance reports by collecting, analyzing, and summarizing data and trends
• AS NEEDED RESPONSIBILITIES
  • Participates in the development of performance improvement plans when a Membership and Enrollment Specialist’s performance is inadequate
  • Researches and resolves complex enrollment, eligibility or billing issues or escalations
  • Supports market exams and audits to provide complete and accurate process documentation
  • Determines operational strategies by conducting needs assessments, performance reviews, capacity planning, and cost/benefit analyses; identifying and evaluating state-of-the-art technologies; defining user requirements; establishing technical specifications, and production, productivity, quality, and customer-service standards; contributing information and analysis to organizational strategic plans and reviews
  • Develops systems by developing customer interaction and voice response systems, and voice networks; designing user interfaces; developing and executing user acceptance test plans; planning and controlling implementations
  • Accomplishes call center human resource objectives by recruiting, selecting, orienting, training, assigning, coaching, counseling, and disciplining employees; administering scheduling systems; communicating job expectations; planning, monitoring, appraising, and reviewing job contributions; planning and reviewing compensation actions; enforcing policies and procedures
  • Meets call center financial objectives by estimating requirements; preparing an annual budget; scheduling expenditures; analyzing variances; initiating corrective actions
  • Maintains equipment by evaluating and installing equipment; developing preventive maintenance programs; calling for repairs; evaluating and implementing upgrades
  • Develop and coordinate outbound call campaigns to meet Bright Health enterprise-wide goals, including: member welcome calls, ongoing check-in and to address special risk issues (Out-of-Network, wellness opportunities)
  • Coordinate and prioritize inbound and outbound campaigns and caseloads
  • Accomplishes organization goals by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments

MANAGER RESPONSIBILITIES

This position has managerial responsibilities over a team of Membership and Enrollment Specialists, Member and Provider Services Specialists, and Mail Operations

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

Key Qualifications:

• High School diploma or GED required; Bachelor’s Degree preferred or equivalent work experience
• Six (6) or more years of health insurance payer experience
• Six (6) or more years of direct customer service support
• Three (3) or more years of management experience with direct supervisory responsibilities required

PROFESSIONAL COMPETENCIES

• Must be highly organized and be able to prioritize work to meet deadlines
• Must be successful working in an environment of ambiguity and change
• Display strong strategic behaviors such as initiative, problem solving, critical thinking, judgment, innovation and independence
• Strong collaborator, problem solver, and ability to work on cross-functional teams, problem solving, and working as a team
• Ability to thrive in an evolving environment, is results and detail oriented, and understands the big picture
• Ability to multitask and remain calm under pressure, especially during peak hours or intense situations
• Exceptional interpersonal, customer service, problem-solving, verbal and written communication, and conflict resolution skills
• Knowledge of management principles and familiarity with company products, services, and policies
• Strong coaching and leadership skills, ability to motivate employees and generate and maintain team unity
• Decisiveness and attention to detail
• Proficiency with necessary technology, including computers, software applications, phone systems, etc.
• Understands regulatory and compliance rules surrounding enrollment and eligibility

WORK ENVIRONMENT

The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. Some travel may be required.