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)
Constructs strategic action plans for potential compliance risks with applicable policies from HIPAA regulations.
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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)
Compiles a list of risks and regulatory challenges for healthcare industries.
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Level 2 Behaviors
(Light Experience)
Assists in implementing industry best practices to secure and protect confidential healthcare information.
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Level 3 Behaviors
(Moderate Experience)
Communicates healthcare policies and procedures to ensure compliance with professional practice standards.
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Level 4 Behaviors
(Extensive Experience)
Delivers healthcare education and training programs to bridge skill gaps in our organization.
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Level 5 Behaviors
(Mastery)
Designs and implements cost-effective strategies to optimize resource utilization within healthcare settings.
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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)
Compiles a list of basic issues and risks for conducting our budget processes.
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Level 2 Behaviors
(Light Experience)
Assists in developing and improving budgeting models, plans, and strategies.
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Level 3 Behaviors
(Moderate Experience)
Compares planned budgets vs. actual expenditures, identifies, reports, and explains variances.
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Level 4 Behaviors
(Extensive Experience)
Anticipates organizational income and expenses to make forecasts and develop budget plans.
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Level 5 Behaviors
(Mastery)
Adapts relevant industry trends on techniques in financial budgeting in our organization.
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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)
Describes different levels of service that exceed, meet or fall short of expectations.
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Level 2 Behaviors
(Light Experience)
Complies with service agreements entered into with customers or provides early notice of any deviations.
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Level 3 Behaviors
(Moderate Experience)
Communicates with customers to determine whether any problems remain after initial resolution and seek feedback.
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Level 4 Behaviors
(Extensive Experience)
Anticipates clients' needs and fulfills them in advance.
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Level 5 Behaviors
(Mastery)
Champions a customer-centric, service excellence culture.
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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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