Manager, Membership Administration

Job Summary

Hybrid Work Environment - Must reside in Hawaii
Pay Range: $68k - $133k, position is eligible for an incentive bonus
Note: Individuals typically begin between the minimum to middle of the pay range

Minimum Qualifications

• Bachelor's degree and five years of related work experience; or equivalent combination of education and related work experience.
• Two years of leadership, supervisory, or management experience.
• In-depth knowledge of managed care, PPO, HMO, Medicaid, Medicare Advantage, and commercial group health plans.
• Working knowledge of claims adjudication systems (e.g., Facets, QNXT, Epic Tapestry, HealthEdge).
• Effective written and verbal communication skills.
• Intermediate working knowledge of Microsoft Office applications including, but not limited to Word, Powerpoint, Outlook and Excel.

Duties And Responsibilities

• Manage and lead a membership admin team by providing training, mentorship, and best practice solutions.
• Manage daily operations of the membership admin team, including inventory analysis, tracking and resolution.
• Serve as the escalation point for complex or disputed cases and drive resolution within defined SLA.
• Monitor and analyze key performance indicators (KPIs) and take corrective actions to improve efficiency, accuracy, and customer satisfaction.
• Collaborate with key stakeholders to include underwriting, LOB, legal, servicing teams to ensure a consistent and integrated approach to accurate and timely case processing.
• Maintain documentation, audit trails, and reporting in line with internal controls and external compliance requirements.
• Contribute to the development and implementation of new policies, procedures, and systems to improve membership admin operations.
• Stay current with changes in laws, regulations, and industry best practices related to membership admin management.