Manager of Member and Provider Service

• Competitive salaries

It’s an exciting time to join the Well Sense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

The primary function of this role is to lead a team of Member Services and Provider Services supervisors and their support staff. The ideal candidate will demonstrate strong leadership, effective coaching abilities, excellent customer service instincts, and a genuine desire to support team members in developing their career paths. This leader will remain flexible, proactive, and committed to driving the business forward.

• Full‑time remote work
• Competitive salaries
• Excellent benefits

• Lead, coach, and motivate supervisors and service staff—40–70 indirect reports—to deliver high‑quality, timely, and accurate service.
• Recruit, develop, and retain high‑performing team members; conduct performance evaluations, create development plans, and support ongoing career growth.
• Foster a positive, motivating, and collaborative work culture.

• Ensure prompt, professional responses to all member and provider inquiries, including call handling, escalations, and claims resolution.
• Analyze call volume trends and adjust staffing to meet service levels and operational goals.
• Monitor key performance indicators (KPIs), track call center metrics, and proactively identify service issues.
• Maintain accuracy and integrity of call data and inquiry records.
• Ensure compliance with corporate, regulatory, contractual, and accreditation requirements.

• Recommend and implement short‑ and long‑term service strategies that improve member and provider satisfaction and overall operational efficiency.
• Develop and maintain policies, procedures, and workflows that ensure quality, consistency, and compliance across product lines.
• Collaborate cross‑functionally to resolve complex issues, support product implementations, and participate in RFR responses.
• Partner with Training and Quality teams to ensure ongoing staff education aligned with organizational needs and market changes.

• Bachelor’s degree or an equivalent combination of education, training, and 6–7 years of related managed care experience.

• Minimum of 5 years of call center experience.
• Minimum of 5 years in a supervisor or manager role.
• Minimum of 5 years of experience in healthcare or managed care.
• Travel to regional offices is required.

• Comprehensive knowledge of applicable contract provisions and accreditation requirements, including but not limited to NCQA, Mass Health, Commonwealth Care, QHP and NH Care Management.
• Comprehensive knowledge of reimbursement, claims adjudication, and payment policies.
• Current knowledge of Facets, Witness, Avaya, CCMS, and all systems used by Customer Care staff and management.

• Pre‑employment background check.

• Strong leadership abilities with a proven track record developing high‑performing teams.
• Excellent verbal and written communication skills; able to communicate effectively at all organizational levels.
• Ability to analyze trends, interpret data, and develop actionable improvement plans.
• Demonstrated success in project management, prioritization, and performance under pressure.
• High attention to detail, including accuracy in proofreading and editing.
• Proficiency with Microsoft Office and call center technology platforms.

• Regular and reliable attendance is an essential function of the position.
• Work is normally performed remotely in a typical interior home office work environment.
• No or very limited exposure to physical risk.
• Occasional travel to corporate office may be required.

• Travel to regional offices required.
• Pre‑employment background check required.

$69,500 – $101,000

This range offers an estimate based on the minimum job qualifications.…