Manager, Member Services - The Health Plan

Position: Manager, Member Services - The Health Plan

Job ID: 159917

Location: US-TX-Houston

Department: Member Services Admin

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p Monday - Friday

About Texas Children's Hospital

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.   To join our community of 14,000+ dedicated team members, visit for career opportunities. You can also learn more about our amazing culture at   Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.


We are searching for a Manager Member Services – someone who works well in a fast-paced managed care setting. In this position, you’ll manage a high performance, culturally sensitive and competent customer service Call Center that supports a rapidly growing, diverse membership and provider community and an expanding portfolio of health plan options. You’ll be responsible for evaluating staff development, customer service results and operational processes to ensure excellence in service, customer satisfaction, and compliance with accrediting and regulatory agencies.  Lastly, you will need to collaborate with counterparts within the Health Plan to initiate and support organization wide performance improvement initiatives.


Think you’ve got what it takes?

Responsibilities :

Job Duties & Responsibilities

  • Manages the day-to-day Inbound/Outbound Call Center activities and staff on a real-time basis to assure service level objectives are met while maintaining quality standards
  • Recommends changes in the Call Center’s basic structure to maintain alignment with the Department and Health Plan’s overall objectives
  • Acts as an internal advocate for external customers, collaborating with other department managers to meet customers’ needs
  • Maintains a current understanding of key processes in place in all departments of the Health Plan and how they affect customers
  • Assures customer concerns are appropriately identified, addressed timely, and documented to minimize risk to the Health Plan
  • Works with Assistant Director to develop and implement strategies to manage and improve internal and external customer relationships and experiences
  • Develops and implements training strategies that support the quality objectives and creates a continuous learning environment for professional growth
  • Ensures compliance with all regulatory (TDI, HIPAA, CMS, etc.) and accrediting (JCAHO, NCQA, etc.) requirements as well as departmental policies and procedures
  • Interviews, assesses, and selects candidates for hire; plans, assigns, and directs work; establishes performance standards; appraises and rewards the performance of direct reports
  • Promotes the Health Plan health coverage options and provides information to parents, advocacy groups, community organizations, and visitors


Being fully vaccinated against COVID-19 is required for all employees at Texas Children’s, unless approved for a medical or religious exemption


Skills & Requirements

  • High School Diploma or GED
  • Bachelor’s Degree in Business Administration, Health Administration, and Marketing or related field preferred (four years of health plan experience may be considered in lieu of the degree)
  • Two (2) years of experience as a Team Leader or Supervisor in Member Services, Claims Administration, or Provider Relations (Call Center Certification may be considered in lieu of one year of health plan experience)
  • Industry knowledge specific to the market served by the Health Plan -- managed health care
  • Understanding of a Call Center business environment, tools and terminology
  • Knowledge of claim processing and claim systems, provider contracting, health care benefits, and how Health Maintenance Organizations work
  • Ability to demonstrate and act on an understanding of the collective concerns of internal and external customers
  • Demonstrates an understanding of how the parts of a problem are related and interact to create an outcome
  • Motivates employees through personal example and displays effective coaching and interpersonal skills
  • Displays effective problem-solving skills, including the ability to resolve conflicts, troubleshoot issues and respond quickly to any situation
  • Must be customer focused, including displaying behaviors such as follow-through and courtesy
  • Ability to communicate effectively and be adaptable
  • Knowledge of Texas Department of Insurance requirements for the handling of Member complaints and appeals is preferred

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