[Hiring] Manager of Member and Provider Service @WellSense Health Plan

Role Description

The primary function of this role is to lead a team of Member Services and Provider Services supervisors and their support staff. The ideal candidate will demonstrate strong leadership, effective coaching abilities, excellent customer service instincts, and a genuine desire to support team members in developing their career paths. This leader will remain flexible, proactive, and committed to driving the business forward.

• Lead, coach, and motivate supervisors and service staff—40–70 indirect reports—to deliver high-quality, timely, and accurate service.
• Recruit, develop, and retain high-performing team members; conduct performance evaluations, create development plans, and support ongoing career growth.
• Foster a positive, motivating, and collaborative work culture.
• Ensure prompt, professional responses to all member and provider inquiries, including call handling, escalations, and claims resolution.
• Analyze call volume trends and adjust staffing to meet service levels and operational goals.
• Monitor key performance indicators (KPIs), track call center metrics, and proactively identify service issues.
• Maintain accuracy and integrity of call data and inquiry records.
• Ensure compliance with corporate, regulatory, contractual, and accreditation requirements.
• Recommend and implement short- and long-term service strategies that improve member and provider satisfaction and overall operational efficiency.
• Develop and maintain policies, procedures, and workflows that ensure quality, consistency, and compliance across product lines.
• Collaborate cross-functionally to resolve complex issues, support product implementations, and participate in RFR responses.
• Partner with Training and Quality teams to ensure ongoing staff education aligned with organizational needs and market changes.

Qualifications

• Bachelor’s degree or an equivalent combination of education, training, and 6–7 years of related managed care experience.
• Minimum of 5 years of call center experience.
• Minimum of 5 years in a supervisor or manager role.
• Minimum of 5 years of experience in healthcare or managed care.
• Travel to regional offices is required.

Requirements

• Comprehensive knowledge of applicable contract provisions and accreditation requirements, including but not limited to NCQA, MassHealth, Commonwealth Care, QHP and NH Care Management.
• Comprehensive knowledge of reimbursement, claims adjudication, and payment policies.
• Current knowledge of Facets, Witness, Avaya, CCMS, and all systems used by Customer Care staff and management.
• Pre-employment background check.

Competencies, Skills & Attributes

• Strong leadership abilities with a proven track record developing high-performing teams.
• Excellent verbal and written communication skills; able to communicate effectively at all organizational levels.
• Ability to analyze trends, interpret data, and develop actionable improvement plans.
• Demonstrated success in project management, prioritization, and performance under pressure.
• High attention to detail, including accuracy in proofreading and editing.
• Proficiency with Microsoft Office and call center technology platforms.

Working Conditions and Physical Effort

• Regular and reliable attendance is an essential function of the position.
• Work is normally performed remotely in a typical interior home office work environment.
• No or very limited exposure to physical risk.
• Occasional travel to corporate office may be required.

Compensation Range

$69,500- $101,000. This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.