Supervisor, Provider and Member Service

Job not on LinkedIn

🔥 3 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟠 Senior

🔴 Lead

👻 Ghost score 10%

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WVU Medicine

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

WVU Medicine is a comprehensive health system affiliated with West Virginia University, providing medical services through a network of hospitals across West Virginia. The system includes notable facilities such as J. W. Ruby Memorial Hospital, WVU Medicine Children's, and various other regional medical centers. WVU Medicine offers a wide range of healthcare services, including specialized and advanced medical treatments such as robotic heart surgery. It's also involved in medical education, research, and community health initiatives, emphasizing a mission of delivering high-quality care to the communities it serves.

📋 Description

• Oversee daily Member and Provider Services operations, policies, procedures, service standards, efficiency, and compliance • Monitor live and recorded member and provider interactions and evaluate performance metrics • Partner with Team Leads to provide coaching, feedback, and development plans • Handle complex or escalated member inquiries about benefits, claims, and eligibility • Resolve difficult provider issues involving claims, referrals, and reimbursement structures • Ensure compliance with CMS, Commercial ACA, Medicare, Medicaid, HIPAA, organizational, state, and federal requirements • Oversee SharePoint and other approved systems, shared sites, documentation, access, policies, procedures, training, and reference materials • Adapt operations to changes in call volume, staffing, scheduling, systems, regulations, emergencies, and outreach initiatives • Identify continuing education needs and complete annual and 90-day reviews • Communicate process and policy changes through staff meetings, face-to-face communication, and email • Participate in cross-departmental meetings and develop quarterly objectives with the manager • Partner with Quality, Training, and Compliance teams on training, onboarding, mentoring, and process-gap remediation • Participate in recruitment, interviewing, selection, onboarding, and retention of Member Services representatives • Promote a collaborative, inclusive, accountable, member-focused work environment

🎯 Requirements

• High school diploma or equivalent AND three years of experience working in a customer service call center environment AND four years of experience working in Commercial/ACA, CMS, Medicare, healthcare compliance, health plan operations, member services, or related environments; OR associate’s degree AND two years of call center experience AND three years in the listed healthcare/health plan environments • Availability Monday through Friday, 8:00 a.m. to 5:00 p.m. during call center operations • Excellent verbal and written communication skills, including communicating complex healthcare, Medicare, and regulatory information clearly and professionally • Knowledge of medical terminology • Ability to monitor and interpret call center performance metrics, quality results, productivity measures, and service-level data • Excellent customer service and telephone etiquette • Strong decision-making, problem-solving, critical-thinking, and analytical skills • Preferred: Bachelor’s degree in healthcare administration, business administration, management, communications, or related field • Preferred: Specialized courses, training, or seminars related to Commercial/ACA, CMS regulations, managed care, healthcare compliance, call center operations, leadership, or business management • Preferred: Two years of experience in healthcare, health insurance, or managed care • Preferred: Two years of experience in a team lead or direct supervisory role overseeing customer service or call center associates • Preferred: Experience supervising employees in a regulated healthcare, health insurance, Commercial/ACA, CMS, or managed care environment

🏖️ Benefits

• Full-time schedule of 40 hours per week • Exempt status • Remote work location as listed for this posting

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