Member & Provider Services Leader

Independent Living Systems, llc; San Diego (CA); On-site; USD 110,000 - 130,000; Full time

Job summary

Independent Living Systems (ILS) seeks a Manager, Member & Provider Services to oversee the contact center supporting members and providers in healthcare and social services. The role leads a team, drives performance, and ensures regulatory compliance to deliver exceptional service.

Responsible for mentoring staff, monitoring metrics, and collaborating with health plan clients and cross-functional teams to improve processes and outcomes, while maintaining confidentiality and PHI handling per

Qualifications

• Bachelor’s degree in Healthcare Administration, Business, or a related field.
• Minimum of 5 years of member or provider services in healthcare or social assistance, 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 protected health information (PHI) in accordance with HIPAA regulations.
• Ability to work independently and as part of a team to balance competing priorities and manage multiple projects simultaneously.
• Ability to work flexible hours as needed to support operational requirements.

Responsibilities

• Lead and manage the daily operations of the Contact Center, ensuring timely and effective resolution of all inquiries.
• Recruit, train, and develop contact center staff to maintain high standards of customer service and operational efficiency.
• Supervise, coach, mentor, and evaluate team members to achieve departmental objectives.
• Oversee investigation and resolution of complex and escalated member and provider cases with guidance to staff.
• Monitor regulatory turnaround times, SLAs, and performance metrics to ensure quality outcomes.
• Develop and maintain quality assurance programs, workflows, and training materials.
• Collaborate with internal and external partners to resolve complex issues and improve service delivery.
• Ensure adherence to federal and state regulations, HIPAA standards, and audit readiness.
• Attend meetings, trainings, leadership forums, and cross-functional workgroups.

Skills

Leadership

Regulatory compliance

HIPAA

PHI handling

Communication

Analytics

Time management

Process improvement

Education

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

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

Tools

CRM software

EHR systems

Job description

Independent Living Systems (ILS) seeks a Manager, Member & Provider Services to oversee the contact center supporting members and providers in healthcare and social services. The role leads a team, drives performance, and ensures regulatory compliance to deliver exceptional service.

Responsible for mentoring staff, monitoring metrics, and collaborating with health plan clients and cross-functional teams to improve processes and outcomes, while maintaining confidentiality and PHI handling per