The Director of Customer Care is responsible for leading the operational activities and services of the Plan’s Member and Provider Service Centers in Massachusetts and New Hampshire. This position is responsible for delivering exceptional service experiences to our members and providers, improving operational efficiencies and building a high performing and engaged culture. Other responsibilities include setting strategic direction, ensuring departmental regulatory requirements are met and using data effectively to drive results.
Manages strategic direction and day to day operations of Customer Care.
Ensures the delivery of accurate and exceptional service to members and providers.
Identifies and implements initiatives to improve member and provider satisfaction levels.
Maintains proper staffing levels across all lines of business.
Tracks trends, makes decisions based on organized information, and supports decisions with articulate written and verbal communications.
Creates annual budget and is responsible for the budget oversight of department. Provides business justification for capital and resource needs.
Utilizes data to drive results and prioritize improvements.
Ability to coach, motivate, inspire and develop team members and to create a positive work environment.
Focus on employee and leader development, including succession planning.
Plan, monitor and adjust performance plans to ensure performance goals are met.
Coordinate the messaging and material used in the service center with the Office of Clinical Affairs, Finance, Legal and Marketing to ensure continuity of message and sharing of information.
Ensures departmental compliance with contractual, regulatory, NCQA, and corporate requirements, guidelines, and goals including turnaround and reporting.
Coordinate, manage and document the operational components of all member advisory committees and member town hall meetings as required by contract or policy.
Develops policies and procedures to improve service delivery and interdepartmental processes to support work processes across product lines.
Oversees the Senior Care Options team to ensure all guidance from EOHHS and CMS is strictly adhered to.
Responsible for the maintenance and monitoring of key indicator reports to proactively identify and communicate existing and potential member and provider service issues and ensures timely delivery of key indicator reports (and communication of identified issues) to operations leadership according to schedule.
Bachelor’s degree in Business Administration, related field or an equivalent combination of education, training and experience is required.
Masters degree preferred
10+ years progressively responsible customer service and/or call center experience, including staff supervision, is required.
Previous health care insurance or managed care experience.
Call center expertise, including systems.
Comprehensive knowledge of State and Federal Medicaid regulations, guidelines and standards.
Competencies, Skills, and Attributes:
Proven leadership skills and ability to build effective teams and manage multiple projects is required.
Outstanding oral and written communication skills and the ability to successfully interact with staff at all levels of the organization and with external constituencies are required.
Ability to manage multiple priorities and work in a fast paced environment.
Ability to make data driven decisions to drive results.
*Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
Internal Number: 292856
About BMC HealthNet Plan
BMC HealthNet Plan is a non-profit managed care organizations committed to providing the highest quality healthcare coverage to underserved populations. In Massachusetts, BMC HealthNet Plan is the business name for Boston Medical Center Health Plan, Inc.; outside Massachusetts, Well Sense Health Plan is the business name.