Contact Center Leader, Member & Provider Services

Independent Living Systems, llc; Modesto (CA); On-site; USD 72,000 - 125,000; Full time

Job summary

Independent Living Systems, LLC in Modesto, CA is seeking a Manager, Member & Provider Services to oversee the daily operations of the contact center supporting members and providers within healthcare and social assistance. You will drive first-call resolution, mentor staff, and collaborate with health plans, providers, and compliance partners to ensure high-quality service and regulatory compliance.

This leadership role requires a Bachelor’s in Healthcare Administration or related field, 5+

Qualifications

• Bachelor’s degree in Healthcare Administration, Business, or related field.
• 5+ years of member or provider services in healthcare, with 2+ years in supervision.
• Experience with Medi-Cal eligibility and benefits.
• Experience using metrics, reports, and quality audits to drive performance.
• Strong organizational, analytical, and time-management skills.
• Excellent communication and interpersonal skills.
• Ability to handle PHI per HIPAA regulations.
• Ability to work independently and in teams.
• Ability to work flexible hours.

Responsibilities

• Demonstrates commitment to Our Mission and models ILS Experience Standards of Excellence.
• Lead and manage the daily operations of the Contact Center, ensuring timely and effective resolution of all inquiries and issues leading to First Call Resolution (FCR).
• Recruit, train, and develop contact center staff to maintain high standards of customer service and operational efficiency; keep staff informed of updates through regular departmental meetings.
• Supervise, coach, mentor, and evaluate team members, establishing and monitoring productivity, quality, timeliness, customer service, and professional development standards to achieve departmental objectives.
• Oversee the investigation and resolution of complex and escalated member and provider cases, providing guidance to staff and ensuring compliance with contractual, regulatory, organizational, and client-specific requirements.
• Monitor regulatory turnaround times, service level agreements, and operational performance metrics to ensure timely resolution, quality outcomes, and customer satisfaction.
• Develop, implement, and maintain quality assurance programs, operational procedures, workflows, training materials, and performance standards to ensure accuracy, consistency, documentation integrity, and compliance across all service recovery activities.
• Collaborate with internal and external partners to resolve complex issues, improve service delivery, and support organizational objectives.
• Ensure adherence to federal and state regulations, health plan requirements, organizational policies, HIPAA standards, confidentiality requirements, and audit readiness, including participation in audits, regulatory reviews, client reporting, and quality improvement activities.
• Attend scheduled meetings, trainings, leadership forums, and cross-functional workgroups.

Skills

Leadership

Communication

Analytical skills

Time management

Education

Bachelor’s degree in Healthcare Administration or related field

Master’s degree in Healthcare Administration

Tools

CRM software

EHR systems

Regulatory reporting tools

Job description

Independent Living Systems, LLC in Modesto, CA is seeking a Manager, Member & Provider Services to oversee the daily operations of the contact center supporting members and providers within healthcare and social assistance. You will drive first-call resolution, mentor staff, and collaborate with health plans, providers, and compliance partners to ensure high-quality service and regulatory compliance.

This leadership role requires a Bachelor’s in Healthcare Administration or related field, 5+