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Supervisor, Provider and Member Service
WVU Medicine. Oversee daily Member and Provider Services operations, policies, procedures, service standards, efficiency, and compliance .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in overseeing member and provider services operations, ensuring compliance with healthcare regulations, and effectively managing call center performance metrics. Strong ability to communicate complex healthcare information clearly while fostering a collaborative and accountable work environment.
Highest-signal resume keywords
Healthcare ComplianceCall Center OperationsPerformance Metrics MonitoringDecision-Making SkillsCustomer Service Excellence
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical TerminologyPerformance Metrics InterpretationRegulatory ComplianceProblem-Solving SkillsAnalytical Skills
Soft Skills
Excellent Communication SkillsCritical ThinkingCoaching and FeedbackTeam LeadershipCollaboration
Tools & Technologies
SharePointCall Center Systems
Industry Keywords
CMSCommercial ACAMedicareMedicaidHealth Plan Operations
About the role
Key responsibilities & impact- Oversee daily Member and Provider Services operations, policies, procedures, service standards, efficiency, and compliance
- Monitor live and recorded member and provider interactions and evaluate performance metrics
- Partner with Team Leads to provide coaching, feedback, and development plans
- Handle complex or escalated member inquiries about benefits, claims, and eligibility
- Resolve difficult provider issues involving claims, referrals, and reimbursement structures
- Ensure compliance with CMS, Commercial ACA, Medicare, Medicaid, HIPAA, organizational, state, and federal requirements
- Oversee SharePoint and other approved systems, shared sites, documentation, access, policies, procedures, training, and reference materials
- Adapt operations to changes in call volume, staffing, scheduling, systems, regulations, emergencies, and outreach initiatives
- Identify continuing education needs and complete annual and 90-day reviews
- Communicate process and policy changes through staff meetings, face-to-face communication, and email
- Participate in cross-departmental meetings and develop quarterly objectives with the manager
- Partner with Quality, Training, and Compliance teams on training, onboarding, mentoring, and process-gap remediation
- Participate in recruitment, interviewing, selection, onboarding, and retention of Member Services representatives
- Promote a collaborative, inclusive, accountable, member-focused work environment
Requirements
What you’ll need- High school diploma or equivalent AND three years of experience working in a customer service call center environment AND four 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 years of call center experience AND three years in the listed healthcare/health plan environments
- Availability Monday through Friday, 8:00 a.m. to 5:00 p.m. during call center operations
- Excellent verbal and written communication skills, including communicating 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
- Preferred: Bachelor’s degree in healthcare administration, business administration, management, communications, or 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 years of experience in healthcare, health insurance, or managed care
- Preferred: Two 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
Benefits
Comp & perks- Full-time schedule of 40 hours per week
- Exempt status
- Remote work location as listed for this posting