Member Operations Supervisor

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

Responsible for managing day-to-day activities of the Member Operations staff. Analyzes existing procedures and develops workflows and processes based on analysis and regulatory changes, and communicates these changes to staff. Manages the internal audit processes and recommends appropriate action. Generates, maintains and distributes member eligibility files to vendors by the secure means and according to the distribution schedule specified by the vendor. Prepares for, and participates in, external regulatory audits (e.g. DOH, DOI, and CMS). Assist the Director with the production of the monthly board reports.

• Bachelor's degree required, Master's degree preferred
• Two years experience in a supervisory role preferred
• Proficiency in MS office (Access, Excel, PowerPoint, Word) required; experience with AMISYS, Market Prominence, Crystal Reports preferred
• Knowledge of managed care organizations, CMS and Federal regulations
• Ability to multitask, think and act independently, delegate appropriately
• Detailed oriented and analytical