Skills & Competencies for Member Services Manager

Member Services Manager job profile

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JOB SUMMARY for Member Services Manager

Responsible for daily activities in the member services function for a health plan or health maintenance organization (HMO).

JOB RESPONSIBILITIES for Member Services Manager

Collects data on member inquiries and service requests and conducts analysis to identify trends and recommend solutions. Ensures service representatives follow established policies for addressing member inquiries and meet service quality goals. Manages the recruitment, hiring, training, scheduling, and performance management of staff.

Member Services Manager SALARY RANGE

BASE 50%
$93,373
TOTAL 50%
$98,905
Job Level
M02
Job Code
HC07000380
Education/Degree
Bachelor's Degree
Reports To
Head of a Unit/Department

Member Services Manager Skills and Competencies List

Proficiency Levels and Behavioural Indicators
Salary.com identifies five increasing levels of proficiency for each skill/competency. Some jobs require only a relatively low level of proficiency in each skill/competency, while other jobs will require a more advanced level of proficiency in the same skill/competency. These levels rate the degree of proficiency (skill level, expertise) we expect the incumbent to perform in the given skill/competency for the given job. Note that we intentionally do not associate timeframes or years of experience in performing the skill/competency because that can be misleading. Proficiency levels identify what the incumbent knows and can do rather than how long they have been doing it. Also, note that the proficiency levels are cumulative, e.g., a level 4 proficiency implies the ability to perform all the behaviors at the lower levels.
Check each Member Services Manager skill and competencie below to view definitions.
JOB FAMILY COMPETENCIES CORE COMPETENCIES
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6 general skills or competencies (Job family competencies) for Member Services Manager

1 Job Family Competencies – HIPAA Compliance
Proficiency Level -2
Skill definition-Abiding in the act protects sensitive patient health information from being disclosed without the patient's consent and knowledge.
Level 1 Behaviors
(General Familiarity)
Cites the policies and procedures on compliance with the HIPAA Privacy Rule.
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Level 2 Behaviors
(Light Experience)
Adheres to policies and procedures in conducting HIPAA compliance process.
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Level 3 Behaviors
(Moderate Experience)
Analyzes and maintains authorization forms, plan documents, and notices to ensure compliance with HIPAA regulations.
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Level 4 Behaviors
(Extensive Experience)
Adopts documentation platforms to improve security for HIPAA compliance of employees and client-proprietary information.
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Level 5 Behaviors
(Mastery)
Stays current of new technologies and processes impacting our organization’s HIPPA compliance program.
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2 Job Family Competencies – Healthcare Industry
Proficiency Level -3
Skill definition-Applying healthcare industry knowledge to manufacture drugs and equipment and offer clinical and other healthcare-related support services.
Level 1 Behaviors
(General Familiarity)
Names the healthcare industry sectors and defines the purpose and functions of each.
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Level 2 Behaviors
(Light Experience)
Uses and maintains electronic health records (EHRs) according to legal and industry standards.
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Level 3 Behaviors
(Moderate Experience)
Works with various industry professionals to formulate new treatment processes for patients.
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Level 4 Behaviors
(Extensive Experience)
Recommends innovations to minimize and control costs in providing quality care to clients.
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Level 5 Behaviors
(Mastery)
Stays abreast of the changes in industry laws to ensure our organization's adherence.
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3 Member Services Manager - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Member Services Manager
Proficiency Level - 4
5 Competency for - Member Services Manager
Proficiency Level - 5

12 soft skills or competencies (core competencies) for Member Services Manager

1 Core Competencies – Budgeting
Proficiency Level -2
Skill definition-Applying specific policies, tools and practices to plan and prepare projected revenues, expenses, cash flows, and capital expenditures.
Level 1 Behaviors
(General Familiarity)
Lists the elements and the steps on how to conduct budgeting.
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Level 2 Behaviors
(Light Experience)
Supplies supporting information and justification for major line items.
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Level 3 Behaviors
(Moderate Experience)
Utilizes software tools and applications to forecast our annual budget accurately.
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Level 4 Behaviors
(Extensive Experience)
Recommends alternative budgeting strategies for resolving budgeting issues in our workplace.
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Level 5 Behaviors
(Mastery)
Introduces technologies, policies, and programs for more effective budget management.
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2 Core Competencies – Service Excellence
Proficiency Level -3
Skill definition-The capability of consistently delivering outstanding customer experiences to meet and even exceed customers' expectations.
Level 1 Behaviors
(General Familiarity)
Names popular customer service Key Performance Indicators (KPIs) and metrics.
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Level 2 Behaviors
(Light Experience)
Utilizes the tools and systems properly to manage customer service tasks.
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Level 3 Behaviors
(Moderate Experience)
Improves service design to better meet clients expectations.
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Level 4 Behaviors
(Extensive Experience)
Looks for long-term benefits to the customer and adjusts service delivery accordingly.
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Level 5 Behaviors
(Mastery)
Leads business process design and re-design to enhance high-quality service delivery.
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3 Member Services Manager - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Member Services Manager
Proficiency Level - 4
5 Competency for - Member Services Manager
Proficiency Level - 5

Summary of Member Services Manager skills and competencies

There are 0 hard skills for Member Services Manager.
6 general skills for Member Services Manager, HIPAA Compliance, Healthcare Industry, Healthcare Knowledge, etc.
12 soft skills for Member Services Manager, Budgeting, Service Excellence, Planning and Organizing, etc.
While the list totals 18 distinct skills, it's important to note that not all are required to be mastered to the same degree. Some skills may only need a basic understanding, whereas others demand a higher level of expertise.
For instance, as a Member Services Manager, he or she needs to be proficient in Budgeting, be skilled in Service Excellence, and be skilled in Planning and Organizing.

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