Customer Service Manager

JOB SUMMARY:

The Customer Service Manager oversees the daily operations of the Customer Service and Call Center department within the MSO, ensuring prompt, accurate, and professional handling of member, provider, and health plan inquiries. This role is responsible for maintaining service excellence across all lines of business—including Medi-Cal, Medicare Advantage, and Commercial plans—while ensuring compliance with regulatory, contractual, and accreditation standards. The Manager leads, trains, and supports a team of representatives, optimizes workflows, monitors performance metrics, and partners cross-functionally to continuously improve customer satisfaction and operational efficiency.

MINIMUM & PREFERRED QUALIFICATIONS:

Education/Training

Minimum: Bachelor’s degree in Business Administration, Healthcare Management, Public Health, or related field.

Experience 

Minimum: 3–5 years of progressive customer service or call center leadership experience within managed care, MSO, IPA, health plan, or healthcare operations setting. Demonstrated experience with call center technologies, telephony systems, and member/provider management systems (e.g., EZ-Cap, Salesforce, or comparable  CRM).

Preferred: Experience supporting or participating in delegation oversight, external audits, and health plan reporting requirements. Experience leading onsite, hybrid, or remote customer service teams. Previous managed care project leadership experience (implementations, benefit changes, system enhancements.

Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.

Skills, Knowledge & Abilities

· Strong leadership, coaching, and team-building skills.

· High proficiency in call center operations, reporting, and CRM systems.

· Excellent written and verbal communication skills.

· Strong problem-solving and conflict resolution skills.

· Advanced data analysis and reporting skills in Excel or BI tools.

· In-depth understanding of managed care operations, including benefits, authorizations, claims, and provider network   structures.

· Strong working knowledge of managed care programs (Medi-Cal, Medicare Advantage, Commercial HMO/PPO).

· Knowledge of regulatory frameworks (CMS, DHCS, DMHC, NCQA) and health plan contract requirements.

· Comprehensive understanding of CMS, DHCS, DMHC, NCQA, and HIPAA regulatory requirements.

· Proven ability to interpret data, identify trends, and implement strategies to improve service performance and customer   satisfaction.

· Familiarity with HIPAA privacy and security rules and customer service documentation standards.

· Ability to manage competing priorities and meet deadlines in a fast-paced environment.

· Ability to build productive relationships with internal teams and external partners.

· Ability to communicate complex information clearly to providers, members, staff, and leadership.

· Ability to implement process improvements and drive department-wide performance.

· Ability to maintain confidentiality, professionalism, and compliance at all times.

· Bilingual in English/Spanish skills preferred.

PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS:

The physical demands described here are represented by those that must be met by an   employee to successfully perform the essential functions of this job. There will be prolonged periods of sitting, working on a computer, and using a telephone/headset. While performing the duties of this job, the employee will regularly be required to walk, stand, bend, lift and/or move up to 20 pounds. Ability to work extended hours during peak periods or audit timelines, as needed. The employee must be able to travel occasionally to meetings, training, or onsite team support (if applicable).  Requires visual acuity to review documents, reports, and system data. Specific vision abilities required by this job include close, distance, color, peripheral vision, depth perception and the ability to adjust focus.