Prospect Medical Systems · 3 days ago
Manager, Customer Service & Member Relations
Orange, CA
Full-time
Remote
Mid, Senior Level
3+ years exp
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Responsibilities
Manage, monitor, and ensure Customer Service and Member Relations Supervisors and direct reports meet, maintain and/or exceed departmental goals.
Create measures and goals to ensure all established standards are satisfactorily met.
Evaluate and assess staff on a monthly (performing 1:1’s) and annual basis, providing timely performance evaluations and implementing corrective action when necessary.
Analyze, track, and trend departmental performance and continually work to find opportunities for process improvement resulting in increased member retention and member satisfaction.
Monitor and ensure regulatory compliance with all Customer Service member contact materials and communications, including monitoring use of Cultural and Linguistic services.
Work with Quality coach to ensure compliance and adherence of company and department policies and procedures.
Utilize resources and tools to identify staff member performance strengths and weaknesses.
Work with other departments to identify ways to improve processes between business units to contribute to member satisfaction, departmental efficiencies and overall company success.
Assess and identify factors which could create company risk and report to leadership with suggestions and plans (if determined) for timely remediation.
Maintain comprehensive knowledge of company and department policies and procedures, goals, and targets.
Assist with the development of job aids and other training tools and materials to be used by staff members to improving overall quality of interactions with customers.
Provide staff members and leadership team with assistance, guidance, support with day-to-day duties and responsibilities as they pertain to knowledge gap, customer care and member retention.
Energize, inspire, and motivate staff members to excel in their day-to-day performance.
Develop and mentor staff members and leadership teams.
Routinely perform staff recognition.
Collaborate with cross-departmental Directors and Supervisors on the matter of solutions, opportunities, and successes.
Liaise with other functional/departmental staff to facilitate service strategies and ensure customer relations and retention.
Attend and present at internal/external customer meetings and internal meetings with other company functions necessary to perform duties and aid development.
Develop and maintain internal/external business relationships.
Qualification
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Required
High School graduate required.
Minimum of three to five (3-5) years management experience in an in-bound and outbound call center environment, preferably with strong Member Retention experience.
At least three to five (3-5) years’ experience in Member/Customer Services preferably in a Managed Care environment (i.e., IPA, MSO, HMO).
Preferred
Bachelors Degree from a four-year college
5+ years of Manager experience in the healthcare industry is strongly preferred.
Knowledge and experience in medical claims processing, referrals and authorizations, CPT, HCPCs and ICD-10 codes preferred.
Industry knowledge of Medi-Cal, Medicare, and Medicaid programs.
Company
Prospect Medical Systems
With approximately 9,000 physicians to serve our 660,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Arizona, Texas, and Rhode Island.
501-1,000 employees
Funding
Current Stage
Late StageLeadership Team
Jim Brown, MBA, MPH
Chief Executive Officer
L
Lily Kam
Chief Financial Officer
Company data provided by crunchbase
