Manager of Member Experience (Customer Service)

At Network Health, our mission is to build healthy and strong Wisconsin communities. Our success is rooted in this commitment, driving every decision we make, including hiring exceptional team members. We are seeking a Manager of Member Experience to join our growing team.

The Manager, Member Experience is responsible for delivering the highest quality and most accurate experiences for members and providers. This includes overseeing detailed documentation, procedures, and outcomes. The role involves developing and implementing strategies, procedures, and best practices to continuously enhance the member experience.

Key responsibilities include:
* Collaborating with the Compliance Department to monitor and adapt to new or changing rules, laws, and regulations.
* Partnering with the Director, Operations to evaluate current business practices, identify opportunities for improvement, and implement updates that drive positive change and align with departmental goals.
* Working closely with the Quality Assurance Department to support initiatives that meet quality goals, including conducting audits, creating action plans, and implementing improvements.
* Leading efforts in employee selection, training, development, deployment, and retention to maintain a high-performing team.
* Analyzing service data to identify root causes of member and provider issues and providing feedback and process improvement recommendations to operational areas impacting the Member Experience Team.

The Manager, Member Experience holds overall accountability for the operations of the Member Experience Team across all lines of business.

Key Responsibilities

• Demonstrates commitment to and behavior aligned with the philosophy, mission, values, and vision of Network Health.
• Applies organizational and regulatory principles, procedures, requirements, and policies appropriately.
• Anticipates resource needs and organizes workflow to meet customer service volume demands, expectations, timelines, and deadlines.
• Ensures compliance with contract terms and regulatory requirements, interpreting customer service inquiries accurately. Partners with Compliance to develop and update processes that align daily workflows with CMS guidelines.
• Identifies and resolves operational inefficiencies to maintain high-quality customer service, meet operational goals, and promote staff morale and job satisfaction.
  Establishes, monitors, and measures key quality and productivity metrics.
• Monitors staff productivity and efficiency, auditing customer service performance for quality and appropriateness. Identifies root causes of performance issues and develops strategies for improvement.
• Conducts trend analysis to identify opportunities for optimizing quality, service, and performance, followed by the development and implementation of actionable plans.
• Develops, implements, and reviews operational policies and procedures for customer service, ensuring standardization and alignment with regulatory, certification, and best practice guidelines.
• Maintains ongoing communication with other departments to monitor the effectiveness of customer service processes. Coordinates responses to executive-level concerns and regulatory inquiries to ensure consistency and timeliness.
• Oversees the preparation of reports for regulatory or certification agencies, ensuring timely and accurate responses.
• Handles escalated calls and concerns unresolved by the Member Experience Team Supervisor.
• Develops departmental goals and strategies, aligning activities to achieve objectives. Prepares and justifies the departmental budget, monitors monthly compliance, and addresses unfavorable variances where possible.
• Recruits, trains, motivates, develops, and retains competent staff to ensure adequate resources. Enhances staff performance through regular meetings, effective training, one-on-one performance discussions, formal reviews, and meaningful goal setting.
• Develops, implements, and monitors service level expectations, goals, and achievements, such as staff statistics, performance metrics, and audit results. Participates in planning and implementing system enhancements.
• Produces and analyzes data to evaluate the plan's effectiveness in meeting member needs. Recommends strategies to senior leadership for exceeding customer expectations.
• Directs and facilitates member outreach and communications to resolve customer service inquiries effectively.
• Performs additional duties as assigned.

Minimum Education Required:
Bachelor's Degree in business/health administration, health management or related field required or eight years of equivalent experience in health insurance or customer service leadership may be substituted for degree.

Minimum Related Years of Experience (per minimum education) Required:

• Minimum of three years of health insurance experience required, including prior experience with ACA, Medicaid, or similar health plans preferred.
• At least two years of leadership required; preferably in health insurance customer service.
• Experience in Health Insurance customer service preferred.

Candidates must reside in the state of Wisconsin for consideration. This position is eligible for our hybrid workplace model to work at your home office (reliable internet is required), and at our office in Brookfield or Menasha.

We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce.