Customer Service Manager

Position Summary

The Customer Service Manager provides strategic oversight and operational leadership for the Customer Service department, ensuring optimal performance across all service channels in alignment with organizational goals, regulatory standards, and member satisfaction objectives. This position is responsible for managing staff performance, driving process improvement initiatives, supporting technology enhancements, and ensuring compliance with CMS and other regulatory bodies. The Manager serves as a key liaison between frontline operations, leadership, and cross-departmental partners to enhance the overall customer experience and operational efficiency.

Essential Duties and Responsibilities

1. Leadership & Oversight: Lead daily operations of the Customer Service department to ensure high-quality service delivery, adherence to SLAs, and a culture of accountability and excellence.

2. Strategic Performance Management: Analyze operational trends and key performance indicators (KPIs) to identify gaps and develop data-driven action plans to improve efficiency, quality, and member satisfaction.

3. Process Optimization: Design, implement, and continuously refine workflows, scripts, and job aids to enhance efficiency, accuracy, and regulatory compliance.

4. Compliance & Quality Assurance: Ensure all departmental operations meet CMS, NCQA, and organizational standards. Partner with Compliance and Quality teams to address audit findings, implement corrective action plans, and sustain compliance readiness.

5. Team Development: Coach, mentor, and develop supervisors, team leads, and representatives through regular performance reviews, feedback sessions, and individualized development plans.

6. Cross-Functional Collaboration: Partner with departments such as Enrollment, Grievances & Appeals, Claims, and Care Coordination to ensure seamless member and provider support and resolution of complex issues.

7. Member Experience: Oversee escalated member interactions, ensuring timely and empathetic resolution. Drive initiatives that improve satisfaction, first-call resolution, and retention.

8. Technology & Reporting: Oversee use of CRM, telephony, and workforce management tools; generate and analyze operational reports to inform decision-making and resource planning.

9. Project Management: Lead departmental projects, such as system implementations, CMS audit preparations, or seasonal readiness planning.

10. Culture & Engagement: Foster a positive, inclusive, and high-performing team culture aligned with company values and mission.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Other duties may apply as assigned by the applicable Manager.

Supervisory Responsibility

Directly manages Customer Service Supervisors, Leads, and Representatives. Responsible for full-cycle management activities, including recruiting, training, performance evaluation, disciplinary actions, and succession planning.

Competencies

To perform the job successfully, an individual should demonstrate the following competencies:

1. Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs workflows and procedures.

2. Design - Demonstrates attention to detail.

3. Leadership - Exhibits confidence in self and others; Inspires and motivates others to perform well; Effectively influences actions and opinions of others; Accepts feedback from others; Gives appropriate recognition to others.

4. Managing People - Includes staff in planning, decision-making, facilitating and process improvement; Takes responsibility for subordinates' activities; Makes self available to staff; Provides regular performance feedback; Develops subordinates' skills and encourages growth; Solicits and applies customer feedback (internal and external); Fosters quality focus in others; Improves processes, products and services.; Continually works to improve supervisory skills.

5. Technical Skills - Assesses own strengths and weaknesses; Pursues training and development opportunities; Strives to continuously build knowledge and skills; Shares expertise with others.

6. Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Meets commitments.

7. Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.

8. Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.

9. Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.

10. Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.

11. Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.

12. Visionary Leadership - Displays passion and optimism; Inspires respect and trust; Mobilizes others to fulfill the vision; Provides vision and inspiration to peers and subordinates.

13. Change Management - Develops workable implementation plans; Communicates changes effectively; Builds commitment and overcomes resistance; Prepares and supports those affected by change; Monitors transition and evaluates results.

14. Delegation - Delegates work assignments; Matches the responsibility to the person; Gives authority to work independently; Sets expectations and monitors delegated activities; Provides recognition for results.

15. Quality Management - Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.

16. Diversity - Shows respect and sensitivity for cultural differences; Promotes a harassment-free environment; Builds a diverse workforce.

17. Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.

18. Organizational Support - Follows policies and procedures; Supports organization's goals and values; Supports affirmative action and respects diversity.

19. Judgment - Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in the decision-making process; Makes timely decisions.

20. Motivation - Sets and achieves challenging goals; Demonstrates persistence and overcomes obstacles; Measures self against standard of excellence.

21. Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives; Organizes or schedules other people and their tasks; Develops realistic action plans.

22. Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.

23. Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.

24. Quantity - Meets productivity standards; Completes work in a timely manner; Strives to increase productivity; Works quickly.

25. Safety and Security - Observes safety and security procedures; Reports potentially unsafe conditions ; Uses equipment and materials properly.

26. Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.

27. Attendance/Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.

28. Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals.; Completes tasks on time or notifies appropriate person with an alternate plan.

29. Initiative - Seeks increased responsibilities; Asks for and offers help when needed.

30. Innovation - Meets challenges with resourcefulness; Generates suggestions for improving work.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

Language Skills

Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.

Mathematical Skills

Ability to add, subtract, multiply, and divide into all units of measure using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Reasoning AbilityAbility to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. This is a largely sedentary role; however, some filing is required. This would require the ability to lift files, open filing cabinets, and bend or stand on a stool as necessary.

While performing the duties of this job, the employee is regularly required to sit and talk or hear. The employee must occasionally lift and/or move up to 10 pounds.

Required Education and Experience

1. Associate's degree from two-year college or university; or one to two years related experience and/or training; or equivalent combination of education and experience.

2. 2 years in a healthcare call center environment.

3. Experience in a managed care environment with member and provider information systems.

4. Previous experience as a Subject Matter Expert in a functional area, managing teams.

5. Expert in Microsoft Office applications.

Preferred Education and Experience

1. Associate's or Bachelor's degree in healthcare administration, public health, or a related field preferred.

2. Experience with CMS reporting and healthcare quality programs (e.g., Medicare Advantage, HEDIS, Star Ratings)

Job Type: Full-time

Pay: $65, $70,000.00 per year

Work Location: Remote