Contra Costa College
Overview
We are offering a permanent full‑time Manager of Member Services position in the Contra Costa Health Plan (CCHP) located in Martinez, CA. The role involves planning, coordinating, and managing operational components of the member grievance and appeal process, implementing new legislation and regulations, and overseeing staff development for managed care.
Responsibilities
Plan and manage the operational components of the member grievance and appeal process.
Implement new legislation and regulations related to member services.
Provide day‑to‑day work direction, management, and supervision of the Member Services unit and staff.
Conduct quarterly internal audits to ensure complaints meet strict regulatory guidelines.
Develop and implement all activities involved in the member retention program.
Submit monthly, quarterly, and annual reports as required by the State Department of Health Services.
Facilitate the resolution of complex member inquiries, complaints, grievances, and appeals, including formal investigations and referrals to third parties when necessary.
Implement and modify department goals and policies to remain compliant with legislative requirements.
Qualifications
Strong management and problem‑solving skills.
Excellent interpersonal skills.
Experience with internal audits.
Ability to respond effectively to appeals.
Great analytical skills to facilitate required change.
Strong organizational skills and priority‑driven mindset.
Competencies Required
Analyzing & Interpreting Data
Critical Thinking
Decision Making
Delivering Results
Action & Results Focused (Taking Initiative)
Adaptability
Attention to Detail
Listening
Oral Communication
Presentation Skill
Writing
Involving Others (Engaging Teams)
Coaching & Developing Others
Leadership
Managing Performance
Teamwork
Minimum Qualifications Education:
Bachelor’s degree in Business Administration, Public Administration, Marketing, or a closely related field from an accredited college or university.
Experience:
Three (3) years of full‑time administrative experience in a health care or health insurance setting with responsibility for member services, marketing, public relations, provider relations, or another major program area. At least one (1) year of that experience must have been as a supervisor or lead.
Substitution for Experience:
Master’s degree in a related field may substitute for one year of experience.
Substitution for Education:
One additional year of qualifying experience may substitute for the required academic major; an associate degree plus two additional years of qualifying experience may substitute for the required education on a year‑for‑year basis up to a maximum of two (2) years.
Desirable Qualifications
Experience with electronic health records – Epic.
Knowledge of local community resources and programs.
Experience working with DSNP populations.
Selection Process
Application Filing and Evaluation:
Applicants will complete a supplemental questionnaire; applications will be evaluated to determine which candidates advance to the next phase.
Remote Oral Assessment:
Qualified candidates will be invited to an online oral assessment measuring competencies. Candidates must achieve an average passing score of 70% or higher on each competency and overall.
Eligibility & Background Checks All Contra Costa County employees are designated Disaster Service Workers. Employment requires affirmation of a loyalty oath and completion of related training. A conditional job offer will be followed by fingerprinting and a background check.
Equal Employment Opportunity Contra Costa County considers all applicants without regard to race, color, religion, sex, national origin, ethnicity, age, disability, sexual orientation, gender, gender identity, gender expression, marital status, ancestry, medical condition, genetic information, military or veteran status, or any other protected category.
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Responsibilities
Plan and manage the operational components of the member grievance and appeal process.
Implement new legislation and regulations related to member services.
Provide day‑to‑day work direction, management, and supervision of the Member Services unit and staff.
Conduct quarterly internal audits to ensure complaints meet strict regulatory guidelines.
Develop and implement all activities involved in the member retention program.
Submit monthly, quarterly, and annual reports as required by the State Department of Health Services.
Facilitate the resolution of complex member inquiries, complaints, grievances, and appeals, including formal investigations and referrals to third parties when necessary.
Implement and modify department goals and policies to remain compliant with legislative requirements.
Qualifications
Strong management and problem‑solving skills.
Excellent interpersonal skills.
Experience with internal audits.
Ability to respond effectively to appeals.
Great analytical skills to facilitate required change.
Strong organizational skills and priority‑driven mindset.
Competencies Required
Analyzing & Interpreting Data
Critical Thinking
Decision Making
Delivering Results
Action & Results Focused (Taking Initiative)
Adaptability
Attention to Detail
Listening
Oral Communication
Presentation Skill
Writing
Involving Others (Engaging Teams)
Coaching & Developing Others
Leadership
Managing Performance
Teamwork
Minimum Qualifications Education:
Bachelor’s degree in Business Administration, Public Administration, Marketing, or a closely related field from an accredited college or university.
Experience:
Three (3) years of full‑time administrative experience in a health care or health insurance setting with responsibility for member services, marketing, public relations, provider relations, or another major program area. At least one (1) year of that experience must have been as a supervisor or lead.
Substitution for Experience:
Master’s degree in a related field may substitute for one year of experience.
Substitution for Education:
One additional year of qualifying experience may substitute for the required academic major; an associate degree plus two additional years of qualifying experience may substitute for the required education on a year‑for‑year basis up to a maximum of two (2) years.
Desirable Qualifications
Experience with electronic health records – Epic.
Knowledge of local community resources and programs.
Experience working with DSNP populations.
Selection Process
Application Filing and Evaluation:
Applicants will complete a supplemental questionnaire; applications will be evaluated to determine which candidates advance to the next phase.
Remote Oral Assessment:
Qualified candidates will be invited to an online oral assessment measuring competencies. Candidates must achieve an average passing score of 70% or higher on each competency and overall.
Eligibility & Background Checks All Contra Costa County employees are designated Disaster Service Workers. Employment requires affirmation of a loyalty oath and completion of related training. A conditional job offer will be followed by fingerprinting and a background check.
Equal Employment Opportunity Contra Costa County considers all applicants without regard to race, color, religion, sex, national origin, ethnicity, age, disability, sexual orientation, gender, gender identity, gender expression, marital status, ancestry, medical condition, genetic information, military or veteran status, or any other protected category.
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