SVP, Customer Experience and Service Operations

CareSource is hiring a senior leader to determine strategies for servicing customers and providers through call center, grievance and appeals, and digital channels. The role leads these functions, aligns technology with business needs, drives operational effectiveness and digital transformation, and ensures regulatory compliance.

Responsibilities:

• Lead and manage the Customer Care, Grievance and Appeals (G & A), and Digital Strategy functions
• Foster strong working relationships with Market team and all areas in which collaboration will be essential to ensure operational effectiveness, drive process improvements, and adherence
• Develop strategy to align technology with business needs to deliver best-in-class member and provider digital experiences across all markets and products
• Advocate for digital transformation within the business, strongly influencing the mindset, behavior and culture of the organization at executive level to ensure that the opportunities are understood and seen as a strategic imperative
• Perform cost/benefit analyses for new technologies
• Seek out new approaches to maximize departmental efficiencies
• Ensure G & A processes drive towards achieving 5 STAR measures
• Periodically survey providers and customers to evaluate performance and establish base lines
• Periodically assess departmental performance through various corporate controls
• Ensure that corporate service level agreements (SLA) are met or exceeded
• Develop and support staff standards to ensure quality encounters with customers and providers
• Monitor all regulatory requirements and oversight of all submissions in existing and future lines of business
• Evaluate and trend grievance information and training evaluations to strengthen all programs
• Analyze data and identify trends monthly to ensure company expectations are met
• Identify information system inefficiencies and formulate recommendations
• Oversee preparation of internal budgets variances for the operational departments
• Develop and maintain an in-depth knowledge of the company’s business and regulatory environments
• Consult with applicable regulatory entities and legal counsel as necessary to assure vendor contracts meet all regulatory standards
• Perform any other job duties as requested

Requirements:

• Bachelor of Science in business, healthcare, management, or related field or equivalent years of relevant experience is required
• Minimum of ten (10)  years experience in a call center environment with at least five (5)  years in leadership is required
• Proficient in Microsoft Office tools
• Strong analytical skills
• Strategic vision and ability to conceptualize key call center trends and identify changing market demands
• Excellent oral, written and interpersonal communication skills
• Strong collaborator with the ability to effectively influence others
• Strong Customer Service orientation
• Strong leadership and strategic management skills
• Ability to adapt quickly to changing business needs
• Effective relationship management skills and ability to maintain strong working relationships
• Critical listening and thinking skills
• Negotiation skills/experience
• Decision making/problem solving skills
• Strong conflict resolution skills
• Planning, problem identification and resolution skills
• Master of Business Administration (MBA), Public Administration (MPA), healthcare or related field is preferred
• MCO experience is preferred