SVP, Customer Experience and Service Operations

Job Summary:

The Vice President, Customer Care is responsible for determining departmental strategies to effectively service customers and providers through the call center, the grievance and appeals process, and digital strategy to ensure operational effectiveness and regulatory compliance.

Essential Functions:

• 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

Education and Experience:

• Bachelor of Science in business, healthcare, management, or related field or equivalent years of relevant experience is required
• Master of Business Administration (MBA), Public Administration (MPA), healthcare or related field is preferred
• Minimum of ten (10) years experience in a call center environment with at least five (5) years in leadership is required
• MCO experience is preferred

Competencies, Knowledge and Skills:

• 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

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation range $150,000-$300,000. CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Energize and Inspire the Organization

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

About Us

The CareSource mission is known as our heartbeat. Just as we support our members to be the best version of themselves, our employees are driven by our mission to create a better world for members, stakeholders and providers.

We are difference-makers who combine compassionate hearts with our unique business expertise to make every opportunity count. Each claim, each phone call, each consumer-centric decision is a chance to change the world for one member, and our employees look for ways to do that every day.

The challenge is, there is no one right way to be the difference and we’re looking for people like you that will rewrite that definition every day. We do what it takes to form creative solutions that make our community and the world just a little better. Discover what it means to be #UniquelyCareSource.