Supervisor Provider and Member Service

wvumedicine; United States; Remote; USD 65,000 - 95,000; Full time

Job summary

WVU Medicine is seeking a Health Plan Member & Provider Services Team Lead to oversee daily call center operations, coach staff, and resolve complex member questions about benefits, claims, and eligibility. You will partner with quality, training, and compliance teams to close knowledge gaps and drive service improvements.

This role emphasizes safeguarding member confidentiality, maintaining professional environment, and contributing to hiring and retention efforts, with a Monday–Friday schedule

Job description

Role overview

Lead the daily work of a health plan’s member and provider service team, ensuring callers receive accurate, helpful support and that operations meet service and compliance standards. You will coach representatives, resolve complex escalations, and work with partner teams to improve service and support the team’s growth.

Responsibilities

• Oversee daily call center operations, reinforcing procedures, service standards, and regulatory requirements.
• Review calls and performance measures; coach team leads and representatives with timely feedback and development plans.
• Resolve complex member questions about benefits, claims, and eligibility, and provider issues involving claims, referrals, and reimbursement.
• Work with quality, training, and compliance partners to address knowledge gaps, support onboarding, and strengthen service practices.
• Identify process improvements, track progress toward departmental goals, and contribute to hiring and retention.
• Protect member confidentiality and maintain a professional, collaborative team environment.

Requirements

• Either a high school diploma or equivalent plus 3 years of call center customer service experience and 4 years in health plan operations, member services, healthcare compliance, or related work; or an associate degree plus 2 years of call center experience and 3 years in a related healthcare or health plan environment.
• Strong written and verbal communication, including the ability to explain healthcare and regulatory information clearly.
• Familiarity with medical terminology and customer service phone practices.
• Ability to interpret quality, productivity, and service-level measures and use them to guide improvements.
• Sound judgment, analytical thinking, and problem-solving skills.

Nice to have

• Bachelor’s degree in healthcare administration, business, management, communications, or a related field, or relevant specialized training.
• Experience in healthcare, health insurance, or managed care, and at least 2 years leading or supervising call center staff, ideally in a regulated environment.

Benefits and work setup

• Full-time, exempt position with a Monday-Friday schedule, 8 a.m.-5 p.m. during call center operations.
• Standard office setting with extended periods using office equipment; work may involve high stress and frequent interruptions.