Overview In this role you lead the membership admin team to ensure accurate, timely processing and strong compliance. You mentor staff, manage daily operations, and act as escalation point for complex cases, driving resolution within SLAs. You monitor KPIs, partner with underwriting, legal, servicing, and other stakeholders to standardize and improve case processing. You'll develop policies and systems that enhance efficiency and stay current with industry regulations, contributing to a compliant, high-performing membership administration function.
Responsibilities- Lead and develop the membership admin team through training and mentorship
- Oversee daily operations including inventory analysis, tracking, and issue resolution
- Escalation point for complex or disputed cases with SLA-driven resolution
- Monitor KPIs and implement corrective actions to boost efficiency, accuracy, and customer satisfaction
- Collaborate with underwriting, LOB, legal, and servicing to ensure integrated case processing
- Maintain documentation, audit trails, and reporting in line with controls and compliance
- Contribute to creation and rollout of new policies, procedures, and systems
- Stay updated on laws, regulations, and industry best practices related to membership administration
Key requirements- Bachelor's degree and five years of related work experience
- Two years of leadership, supervisory, or management experience
- Deep 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 proficiency in Microsoft Office (Word, PowerPoint, Outlook, Excel)
- leadership and people management
- cross-functional collaboration
- communication (written and verbal)
- Facets
- QNXT
- Epic Tapestry
