Supervisor, Provider and Member Service

Peak Health

. Oversee daily operations of the Member and Provider Services team, ensuring policies, procedures, service standards, efficiency, and compliance .

Posted 11/6/2026full-timeRemote • United StatesSeniorLeadWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in overseeing member and provider services operations, ensuring compliance with CMS, Medicare, Medicaid, and HIPAA regulations. Proficient in coaching and developing teams while managing complex inquiries and maintaining high service standards.

Highest-signal resume keywords

Healthcare ComplianceMember Services ManagementCall Center OperationsCoaching And MentoringPerformance Metrics Analysis

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Healthcare OperationsClaims ProcessingEligibility VerificationRegulatory CompliancePerformance Metrics MonitoringDecision-MakingProblem-SolvingAnalytical SkillsMedical TerminologyCustomer Service

Soft Skills

Excellent CommunicationTeam LeadershipCollaborationCritical ThinkingAdaptability

Tools & Technologies

SharePointCall Center SystemsTraining Materials

Industry Keywords

CMS RegulationsCommercial ACAMedicareMedicaidHealth Plan OperationsManaged CareCustomer Service Standards

About the role

Key responsibilities & impact

Oversee daily operations of the Member and Provider Services team, ensuring policies, procedures, service standards, efficiency, and compliance
Monitor live and recorded member and provider interactions and evaluate performance metrics
Provide coaching, actionable feedback, development plans, training, mentoring, and onboarding support
Handle complex or escalated member inquiries regarding benefits, claims, and eligibility
Resolve difficult provider issues involving claims, referrals, and reimbursement structures
Ensure operations and interactions comply with CMS, Commercial ACA, Medicare, Medicaid, HIPAA, organizational, state, and federal requirements
Oversee SharePoint and approved systems, departmental documentation, policies, procedures, access, and training materials
Adapt operations to call volume, staffing, scheduling, business, regulatory, system, emergency, and outreach needs
Identify continuing education needs and complete annual and 90-day reviews
Keep staff informed of process and policy changes through meetings, face-to-face communication, and email
Participate in cross-departmental meetings concerning Customer Service and Insurance workflows
Organize daily priorities to achieve productivity, accountability, and efficiency
Work with the manager to develop and attain quarterly objectives
Maintain confidentiality and discretion in compliance with HIPAA and Peak policies
Partner with Quality, Training, and Compliance teams to deliver training and address knowledge or process gaps
Promote a professional, collaborative, inclusive, accountable, and member-focused work environment
Participate in recruitment, interviewing, selection, onboarding, and retention of Member Services representatives

Requirements

What you’ll need

High school diploma or equivalent AND three (3) years of experience working in a customer service call center environment AND four (4) years of experience working in Commercial/ACA, CMS, Medicare, healthcare compliance, health plan operations, member services, or related environments; OR associate’s degree AND two (2) years of customer service call center experience AND three (3) years of experience in Commercial/ACA, CMS, Medicare healthcare compliance, health plan operations, member services, or related environments
Preferred: Bachelor’s degree in healthcare administration, business administration, management, communications, or a related field
Preferred: specialized courses, training, or seminars related to Commercial/ACA, CMS regulations, managed care, healthcare compliance, call center operations, leadership, or business management
Preferred: two (2) years of experience in healthcare, health insurance, or managed care
Preferred: two (2) years of experience in a team lead or direct supervisory role overseeing customer service or call center associates
Preferred experience supervising employees in a regulated healthcare, health insurance, Commercial/ACA, CMS, or managed care environment
Availability Monday through Friday, 8:00 a.m. to 5:00 p.m. during call center operations
Knowledge of CMS requirements, Commercial ACA, Medicare, Medicaid, HIPAA, and applicable state and federal regulations
Understanding of healthcare and health plan operations, including eligibility, enrollment, claims, benefits, provider networks, pharmacy coverage, authorizations, billing, grievances, appeals, and reimbursement
Excellent verbal and written communication skills, including ability to communicate complex healthcare, Medicare, and regulatory information clearly and professionally
Knowledge of medical terminology
Ability to monitor and interpret call center performance metrics, quality results, productivity measures, and service-level data
Excellent customer service and telephone etiquette
Strong decision-making, problem-solving, critical-thinking, and analytical skills
Ability to sit, stand, walk, and use standard office equipment for extended periods