Manager, Member Services

Job Description

Company Description Mint Health Plans is committed to addressing the rising cost of healthcare by providing organizations with flexible, customized benefit solutions that fit their specific needs. With more than 25 years of experience in health, dental, and vision administrative services, the company brings deep expertise and reliability to its clients. Mint Health Plans focuses on affordability, transparency, and quality to help employers and members make informed decisions about their benefits. The organization is redefining benefits administration through innovative services designed to improve the member experience and support long-term client partnerships.

The Manager, Member Services is responsible for the overall leadership, management, and operational performance of the Member/Provider Services department. This position oversees all customer service-related functions across the organization's medical, dental, and vision benefit programs, ensuring consistent, accurate, timely, and professional service to members, providers, employer groups, and business partners.

The Manager, Member Services will provide strategic and operational oversight of the customer service team, establish and maintain departmental policies and procedures, oversee training and employee development, manage complex escalations, and ensure departmental performance aligns with organizational standards and objectives.

This role serves as the primary point of accountability for customer service operations and works closely with executive management, account management, claims, eligibility, and other departments to resolve service issues, improve operational efficiency, and deliver an exceptional customer experience.

Key Responsibilities

Department Leadership and Management

Oversee all day-to-day operations and functions of the Member/Provider Services department.

Provide direct supervision, leadership, coaching, and ongoing development of customer service personnel.

Establish clear departmental expectations, performance standards, and accountability measures.

Manage employee schedules, staffing assignments, attendance, and coverage to ensure appropriate service levels during business hours.

Conduct regular employee performance evaluations, provide constructive feedback, and address performance concerns as necessary.

Participate in hiring, onboarding, employee development, and disciplinary processes in coordination with executive management.

Foster a positive, professional, and service-oriented team environment.

Ensure departmental operations remain efficient, organized, and aligned with company objectives.

Customer Service Operations and Oversight

Maintain overall responsibility for the quality, accuracy, consistency, and timeliness of customer service provided to members, providers, employer groups, and business partners.

Oversee all inbound and outbound customer service activities, including telephone calls, emails, service requests, and other communication channels.

Ensure inquiries related to benefits, claims, eligibility, provider networks, billing, and other administrative functions are handled appropriately.

Monitor departmental workloads, response times, unresolved inquiries, and service levels to ensure established standards are consistently met.

Serve as the primary escalation point for complex, sensitive, or unresolved customer service issues.

Take ownership of escalated situations and coordinate with appropriate departments to achieve timely and satisfactory resolutions.

Establish procedures for tracking, documenting, escalating, and resolving customer service concerns.

Identify recurring member and provider issues and implement corrective actions to reduce future occurrences.

Provide direct customer service support when necessary to maintain service continuity.

Training, Development, and Quality Assurance

Develop, implement, and maintain a comprehensive departmental training program and customer service operations manual.

Establish standardized procedures, workflows, and reference materials to support consistent service delivery.

Oversee the onboarding and training of new customer service employees.

Conduct ongoing training to ensure employees maintain a thorough understanding of benefit plans, company procedures, system functionality, and customer service expectations.

Develop and maintain quality assurance standards for customer service interactions.

Regularly review calls, written communications, and service documentation to evaluate accuracy, professionalism, and overall service quality.

Identify employee knowledge gaps and implement targeted coaching and additional training as needed.

Ensure departmental personnel remain informed of changes to benefit plans, administrative procedures, provider networks, and organizational policies.

Performance Management and Reporting

Establish, monitor, and manage departmental key performance indicators (KPIs) and service standards.

Oversee the preparation and analysis of customer service reports, including call volumes, response times, abandoned calls, resolution rates, escalations, and other relevant performance metrics.

Evaluate departmental trends to identify operational challenges, staffing needs, and opportunities for improvement.

Provide regular departmental performance updates to executive management.

Develop and implement corrective action plans when performance falls below established expectations.

Ensure accurate and complete documentation of customer service activities and escalated issues.

Utilize available reporting tools and technology to improve departmental efficiency, accountability, and service quality.

Cross-Departmental Collaboration and Escalation Management

Serve as the primary customer service liaison between the Member/Provider Services department and other operational departments.

Work closely with Account Management to address escalated member issues, employer group concerns, and service-related requests.

Coordinate with Claims, Eligibility, Provider Relations, and other departments to facilitate timely issue resolution.

Ensure customer service personnel receive accurate and timely information from other departments.

Identify communication gaps or operational breakdowns and work with management to implement effective solutions.

Participate in internal operational meetings and contribute to decisions affecting customer service delivery.

Assist executive management with high-priority member, provider, and client-related concerns.

Process Improvement and Operational Development

Continuously assess departmental procedures, systems, and workflows to identify opportunities for improvement.

Develop and implement initiatives designed to enhance customer satisfaction, increase operational efficiency, and improve service consistency.

Recommend technological solutions, automation opportunities, and process enhancements to streamline customer service functions.

Establish standardized escalation procedures and accountability measures to ensure effective issue resolution.

Ensure departmental policies and procedures are properly documented, communicated, and consistently followed.

Support organizational growth by developing scalable customer service processes and operational structures.

Assist executive management with departmental planning, resource allocation, and other operational initiatives.

Compliance and Professional Standards

Ensure customer service operations comply with applicable company policies, privacy requirements, and regulatory standards, including HIPAA.

Maintain appropriate confidentiality and security of member, provider, and employer group information.

Ensure staff provide accurate information regarding plan benefits, claims, eligibility, and administrative processes.

Promote professional communication and ethical conduct across all customer service interactions.

Identify potential compliance concerns and promptly escalate them to appropriate management personnel.

Additional Management Responsibilities

Participate in departmental planning and operational strategy discussions with executive management.

Assist with special projects, system implementations, and organizational initiatives affecting customer service operations.

Act as the primary departmental resource for complex operational questions and decisions.

Perform other management and operational duties as assigned.

Qualifications

Education and Experience

Minimum of 5 years of experience in customer service, member services, or related operations, preferably within the health insurance, employee benefits, or healthcare administration industry.

Minimum of 3 years of experience in a supervisory, management, or team leadership capacity.

Demonstrated experience managing customer service teams, departmental workflows, employee performance, and service quality.

Experience developing standard operating procedures, training programs, and performance reporting.

Familiarity with self-funded health plans, third-party administration, claims processing, eligibility, and provider service operations is strongly preferred.

Associate's or bachelor's degree in business administration, healthcare administration, management, or a related field preferred; equivalent professional experience will be considered.

Skills and Competencies

Strong leadership, personnel management, and decision-making abilities.

Proven ability to manage multiple operational priorities while maintaining departmental accountability.

Excellent written and verbal communication skills, including the ability to handle sensitive or escalated situations professionally.

Strong analytical and problem-solving abilities with experience interpreting operational performance metrics.

Ability to establish, implement, and enforce departmental policies and procedures.

Experience developing training materials, leading employee development programs, and evaluating staff performance.

Strong organizational skills with exceptional attention to detail and follow-through.

Proficiency in Microsoft Office applications, including Excel, Word, Outlook, and PowerPoint.

Ability to learn, manage, and optimize customer service software, telephone systems, and administrative platforms.

Familiarity with healthcare privacy requirements, including HIPAA.

Basic understanding of accounting principles, reporting processes, and SFTP file transfers preferred.

Key Leadership Competencies

Accountability: Takes ownership of departmental performance, service quality, and timely issue resolution.

Leadership: Provides clear direction, develops employees, and maintains a productive and professional work environment.

Customer Focus: Demonstrates a commitment to delivering exceptional service and positive experiences for members, providers, and clients.

Problem-Solving: Identifies root causes of recurring issues and implements effective, sustainable solutions.

Operational Excellence: Establishes efficient processes, monitors performance, and maintains consistently high service standards.

Communication: Effectively communicates with employees, management, business partners, and other departments.

Adaptability: Successfully manages changing priorities, increasing workloads, and evolving organizational needs.

Collaboration: Builds effective working relationships across departments to support shared business objectives.

Continuous Improvement: Proactively identifies opportunities to strengthen departmental performance and customer satisfaction.