Healthcare Member & Provider Services Manager

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

Job summary

Independent Living Systems, LLC in Fontana, CA, seeks a Manager, Member & Provider Services to oversee the contact center operations supporting members and providers in the healthcare and social assistance sector.

You will lead a team, ensure timely resolution, quality service, regulatory compliance, and collaboration with health plans, clinicians, and internal teams to drive performance and customer satisfaction.

Qualifications

• Bachelor’s degree in Healthcare Administration, Business, or a related field.
• 5+ years in member or provider services in healthcare or social services, with at least 2 years in a supervisory role.
• Experience with Medi-Cal eligibility and benefits.
• Demonstrated experience using operational metrics, reports, and quality audits to drive performance improvements.
• Strong organizational, analytical, and time-management skills with the ability to effectively manage multiple priorities and deadlines.
• Excellent communication, organizational, and interpersonal skills.
• Ability to maintain confidentiality and handle PHI in accordance with HIPAA regulations.
• Ability to work independently and as part of a team to balance competing priorities and manage multiple projects.
• Ability to work flexible hours as needed to support operational requirements.

Responsibilities

• Lead and manage the daily operations of the Contact Center to achieve 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.
• Supervise, coach, mentor, and evaluate team members against productivity, quality, timeliness, and professional development standards.
• Oversee investigation and resolution of complex and escalated member and provider cases with guidance on staff.
• Monitor regulatory turnaround times, service level agreements, and performance metrics to ensure timely resolution and quality outcomes.
• Develop, implement, and maintain quality assurance programs, workflows, and training materials for compliance and consistency.
• Collaborate with internal and external partners to resolve complex issues and improve service delivery.
• Ensure adherence to federal and state regulations, health plan requirements, HIPAA standards, and audit readiness.

Skills

Leadership

Communication

Regulatory compliance

PHI handling / HIPAA

Analytical

Time management

Education

Bachelor's degree in Healthcare Administration, Business, or related field

Tools

CRM software

EHR systems

Healthcare information systems

Job description

Independent Living Systems, LLC in Fontana, CA, seeks a Manager, Member & Provider Services to oversee the contact center operations supporting members and providers in the healthcare and social assistance sector.

You will lead a team, ensure timely resolution, quality service, regulatory compliance, and collaboration with health plans, clinicians, and internal teams to drive performance and customer satisfaction.