Member Services Manager

Medical Associates Health Plans is hiring a Manager of Member Services to join our team!

Where You Will Be Working: 

Medical Associates Health Plans offers highly rated commercial and Medicare insurance solutions deeply integrated with the clinic's healthcare network. This position is an onsite position, located at the Medical Associates Health Plans in Dubuque, Iowa.

What You Will Be Doing:

The Member Services Manager oversees member support, eligibility and enrollment, assigned appeals and grievance functions, and the resolution of escalated issues. This role provides leadership in staff development, workforce planning, service quality, process improvement, and the adoption of approved technology to enhance the member experience and operational effectiveness.

Major Responsibilities

• Service Operations and Workforce Planning 
• Manage daily phone, written, digital, and in-person service workflows, including reception coverage.
• Plan staffing based on service demand, workload, enrollment activity, PTO, training, and overtime.
• Monitor service levels, response times, call abandonment, and backlogs; address gaps, report performance, and ensure accurate benefit and coverage information.
• People Leadership and Staff Development 
• Lead hiring, onboarding, scheduling, coaching, performance evaluations, and employee development.
• Establish service and performance expectations, address concerns with Human Resources, and assess staff proficiency.
• Develop cross-training, backup coverage, and succession plans while supporting team leaders and communicating changes effectively.
• Eligibility and Enrollment Operations 
• Oversee eligibility and enrollment workflows, ensuring accurate member data and timely processing.
• Coordinate file issues, reconciliation, and corrections with Configuration, IT, vendors, and other departments.
• Maintain appropriate controls and documentation and ensure staff follow procedures and escalate exceptions.
• Quality, Compliance, and Issue Resolution 
• Oversee quality reviews of calls, correspondence, transactions, and documentation; address errors and maintain current departmental policies and procedures.
• Coordinate assigned appeals and grievances, including deadlines, documentation, and reporting, with Compliance.
• Track escalated issues through resolution, coordinate corrections with responsible teams, and ensure compliance with applicable regulations and accreditation requirements.
• Process Improvement and Technology Adoption 
• Identify operational risks and workflow improvements, implement approved changes, and evaluate results.
• Maintain current SOPs, training resources, and approved knowledge content; lead adoption of approved technology, automation, and AI-assisted tools.
• Partner with IT, Analytics, Compliance, and content owners on requirements, testing, and training while reinforcing accuracy, source verification, human review, and privacy.
• Member Communications and Coordination 
• Coordinate accurate, timely member communications and materials for enrollment, renewals, terminations, ID cards, and digital information.
• Partner with content owners, Compliance, the Mailroom, and vendors to manage reviews, distribution, and delivery issues.
• Represent Member Services in product, system, and group implementations, coordinating staff readiness and workflows with Claims, Configuration, Sales, account management, and other departments.
• Other Duties 
• Complete additional projects and responsibilities as assigned.

What You Bring to the Role

• Strong leadership, communication, and employee development skills.
• Experience managing service operations, staffing, workflows, and performance metrics.
• Strong problem-solving, collaboration, and continuous improvement skills, with an interest in using technology to improve service and efficiency.

Expectations:

1. Strategic Planning and Goal Setting: Proactively manage projects and long-term goals, establish timelines and action owners, ensure commitments are met.
2. Decision Making and Resource Management: Gather information, evaluate impacts and risks, make timely decisions, manage resources responsibly.
3. Leadership and Team Building: Set an example, model respectful and cooperative relationships, ensure team understanding and collaboration, motivate employees, address morale issues.
4. Communication and Relationship Building: Communicate openly and effectively, build commitment and loyalty, manage difficult issues with empathy and clarity, promote a non-threatening environment for expressing opinions. Interact professionally, build rapport, treat everyone with respect.
5. Innovation and Change Management: Implement new ideas and technologies, support change, remove obstacles, ensure resources are available.
6. Performance Management and Development: Set performance and behavioral standards, promote personal accountability, encourage skill development and goal attainment, provide feedback and evaluations, support employee development and succession planning.  Remain current with skills and industry knowledge and seek feedback for continual personal development.
7. Customer Focus and Commitment to Excellence: Anticipate internal and external customer needs, respond proactively and ensure satisfaction. Demonstrate commitment to excellence, deliver quality work.
8. Policy Compliance and Ethical Behavior: Comply with Medical Associates policies and behave in an ethical manner at all times. 

Benefits Package Includes:  

• Single or Family Health Insurance with discounted premium rates for wellness program participation.
• 401k with immediate matching (50% on the dollar up to 7% of pay) + additional annual Profit Sharing
• Flexible Paid Time Off Program (29 days off/year)
• Medical and Dependent Care Flex Spending Accounts
• Life insurance, Long Term Disability Coverage, Short Term Disability Coverage, Dental Insurance, etc.  

Knowledge and Skills:

 Experience: At least three years of relevant experience in member or customer service, health insurance, healthcare administration, or comparable service operations, including demonstrated team leadership, coaching, or staff development. Formal supervisory experience is preferred. Experience with health plan or TPA operations, Medicare and commercial products, eligibility and enrollment, appeals and grievances, or contact-center management is preferred.

Education: High school diploma or equivalent required. An associate or bachelor's degree in business, healthcare administration, management, or a related field is preferred. Relevant experience will be considered alongside education.

Operational Skills: Ability to interpret service and workload data, plan coverage, prioritize competing demands, document procedures, manage escalations, and coordinate work across departments. Demonstrated ability to implement changes, identify risks, develop practical solutions, and evaluate service quality and operational results.

Technology Skills: Proficiency with business applications, operational systems, and reports; ability to learn new technology and train staff. Experience implementing knowledge-management tools, automation, or AI-assisted workflows is preferred. Ability to assess output against approved information and follow established privacy, security, and escalation practices

Interpersonal Skills: Strong written and verbal communication, sound judgment, discretion, and diplomacy. Ability to explain complex information clearly, handle sensitive concerns with empathy, coach employees, address difficult issues, and build cooperative relationships with members, colleagues, employers, brokers, and vendors. Maintain confidentiality and work effectively across departments.