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- Manage and lead a membership admin team by providing training, mentorship, and best practice solutions.
- Manage daily operations of the membership admin team, including inventory analysis, tracking and resolution
- Serve as the escalation point for complex or disputed cases and drive resolution within defined SLA.
- Monitor and analyze key performance indicators (KPIs) and take corrective actions to improve efficiency, accuracy, and customer satisfaction
- Collaborate with key stakeholders to include underwriting, LOB, legal, servicing teams to ensure a consistent and integrated approach to accurate and timely case processing.
- Maintain documentation, audit trails, and reporting in line with internal controls and external compliance requirements.
- Contribute to the development and implementation of new policies, procedures, and systems to improve membership admin operations.
- Stay current with changes in laws, regulations, and industry best practices related to membership admin management. Performs all other miscellaneous responsibilities and duties as assigned or directed.
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Qualifications
- Bachelor's degree and five years of related work experience; or equivalent combination of education and related work experience.
- Two years of leadership, supervisory, or management experience.
- Â In-depth knowledge of managed care, PPO, HMO, Medicaid, Medicare Advantage, and commercial group health plans
- Working knowledge of claims adjudication systems (e.g., Facets, QNXT, Epic Tapestry, HealthEdge)
- Effective written and verbal communication skills
- Intermediate working knowledge of Microsoft Office applications including, but not limited to Word, Powerpoint, Outlook and Excel.
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