Customer Service Manager

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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 maintains service excellence across all lines of business—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.

This position operates at a management level with responsibility for both strategic oversight and hands‑on leadership within a highly regulated managed care environment. The Customer Service Manager differs from supervisory roles by having broader accountability for compliance alignment, interdepartmental coordination, delegation oversight support, audit preparation, and system‑level problem resolution. The role requires advanced knowledge of CMS, DHCS, DMHC, NCQA, and health plan requirements, as well as expertise in call center operations and healthcare customer service best practices.

• Lead, coach, and manage the daily operations of the Customer Service team to ensure timely and accurate responses to member, provider, and health plan inquiries.
• Monitor call center metrics (AHT, ASA, FCR, abandonment rate, service level performance) to ensure compliance with internal expectations and contractual obligations.
• Serve as an escalation resource for complex cases, coordinating resolutions with Claims, Utilization Management, Credentialing, Contracting, IT, and Quality departments.
• Develop, maintain, and enforce policies and procedures related to customer service workflows in alignment with DHCS, CMS, DMHC, NCQA, HIPAA, and health plan requirements.
• Analyze trends and recurring issues to identify root causes, recommend operational improvements, and implement corrective action plans.
• Oversee documentation of all interactions in customer service platforms (e.g., EZ‑Cap, Salesforce, CRM systems) ensuring accuracy, timeliness, and reporting readiness.
• Prepare reports, summaries, audit documentation, call logs, and dashboards for internal leadership and contracted health plans.
• Coordinate new hire training, ongoing staff development, competency validation, and regulatory education.
• Maintain and optimize call center tools, including IVR functionality, call routing systems, and case management databases.
• Support implementation of new lines of business, benefit updates, provider network expansions, contract changes, and system upgrades.
• Foster a culture of service excellence, teamwork, compliance, and professionalism across the department.

May be assigned special project or other assignments and work tasks that are generally within the scope and level of the position, and relative to the need for flexible company operations.

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

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.