Healthcare Member & Provider Services Manager

Florida Community Care, LLC.; Modesto (CA); On-site; USD 7,200 - 125,000; Full time

Job summary

Independent Living Systems (ILS) in Modesto, CA, is seeking a Manager, Member & Provider Services to lead the contact center operations for members and providers in the healthcare and social assistance sectors.

You will recruit, train, and mentor staff, monitor performance metrics, ensure First Call Resolution, and ensure HIPAA compliance while collaborating with health plan clients and internal teams to deliver exceptional service.

Qualifications

• Bachelor’s degree in Healthcare Administration, Business, or related field.
• Minimum 5 years in member/provider services in healthcare or social assistance, with 2+ years in supervision.
• Medi-Cal eligibility and benefits experience.
• Strong organizational, analytical, and time-management skills; handles multiple priorities.
• Excellent communication and interpersonal skills; maintains confidentiality (PHI).

Responsibilities

• Lead daily operations of the Contact Center to achieve First Call Resolution (FCR).
• Recruit, train, and develop staff; communicate updates via regular meetings.
• Supervise, coach, mentor, and evaluate team against productivity and quality standards.
• Oversee investigations of complex member/provider cases, ensuring compliance.
• Monitor SLAs, regulatory turnaround times, and performance metrics.

Skills

Member/provider services experience

Supervisory experience

Medi-Cal eligibility benefits

Operational metrics

HIPAA/PHI handling

Communication skills

Education

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

Master’s degree in Healthcare Administration, Public Health, or Business Administration

Job description

Independent Living Systems (ILS) in Modesto, CA, is seeking a Manager, Member & Provider Services to lead the contact center operations for members and providers in the healthcare and social assistance sectors.

You will recruit, train, and mentor staff, monitor performance metrics, ensure First Call Resolution, and ensure HIPAA compliance while collaborating with health plan clients and internal teams to deliver exceptional service.